Clinical Determinants for the Recovery of Fungal and Mezlocillin-Resistant Pathogens from Bile Specimens

Boris P. Ehrenstein Lea Salamon Hans-Jo rg Linde Helmut Messmann J urgen Scho lmerich Thomas Glu ck Klinik und Poliklinik fur Innere Medizin I Klinikum der Universitat Institut fur Medizinische Mikrobiologie und Hygiene Universitat Regensburg Regensburg Germany We conducted a retrospective analysis of all bile specimens obtained for routine cultures from January 1995 through December 1999 at our tertiary care hospital. Results of microbiologic testing were linked to clinical parameters gathered by means of chart review. A total of 722 isolates were cultured from 345 of 454 bile specimens obtained from 288 individual patients. Prior receipt of a 17-day course of antibiotics (odds ratio [OR], 5.7), extensive leukocytosis (leukocyte count, 120,000 cells/mL) on admission (OR, 7.8), endoscopic or percutaneous biliary manipulation during the previous 14 days (OR, 2.9), and treatment in an internal medicine ward (OR, 2.5) were independent factors significantly associated (P .05) with recovery of Candida species from bile specimens. Culture of mezlocillin-resistant bacteria from bile specimens was independently associated with the specimen having been obtained 11 week after admission (OR, 3.8), lack of history of endoscopic biliary drainage (OR, 3.2), and high serum aspartate aminotransferase levels (172 U/L) on admission (OR, 2.6). Prospective studies are warranted to evaluate accordingly adjusted empiric therapies for biliary infections. - MATERIALS AND METHODS 3 . B 54 83 1 6 6 2 3 7 A 4 9 A A 0 1 0 A A A e 0 7 4 1 N 1 N N 1 1 N N N th 5 6 [1 91 O N N N ][5 999 TCD M N N N 6 5 1 P 1 1 C B o to RESULTS Antibiotic(s) Piperacillin Piperacillin-sulbactam Mezlocillin Cefuroxime Aerobic isolates, % susceptible Gramnegative Grampositive 53 79 Characteristic Female sex Treatment in internal medicine warda Age 60 years Cholangitis All etiologies Benign etiology Malignant etiology Cholecystitis Malignant biliary tract disease, no fever or inflammation Duration of symptoms !8 days Temperature 138.0 C Laboratory values Leukocyte count 120,000 cells/mL Serum C-reactive protein 1100 mg/L Serum total bilirubin 14 mg/100 mL Serum aspartate aminotransferase 172 IU/L Serum alanine aminotransferase 188 IU/L Serum alkaline phosphatase 1680 IU/L Absence of history of ERCP History of PTCD History of biliary tract surgery ERCP or PTCD in the 14 previous days Current use of antacids Method by which specimen was obtained ERCP PTCD During surgery Specimen obtained after the seventh day of hospitalization Duration of pretreatment with antibiotic therapy of 17 days Percentage of patients 40 60 NOTE. ERCP, endoscopic retrograde cholangiopancreaticography; PTCD, percutaneous transhepatic cholangiography or drainage. a As opposed to a surgical ward. Characteristic Female sex Treatment in an internal medicine warda Age 60 years Cholangitis Cholecystitis Malignant biliary tract disease, no fever Duration of symptoms !8 days Temperature 138.0 C Laboratory values Leukocyte count 120,000 cells/mL Serum C-reactive protein 1100 mg/L Serum total bilirubin 14 mg/dL Serum aspartate aminotransferase 172 IU/L Serum alanine aminotransferase 188 IU/L Serum alkaline phosphatase 1680 IU/L Absence of history of ERCP History of PTCD History of biliary tract surgery ERCP or PTCD in the 14 previous days Current use of antacids Specimen obtained by ERCP Specimen obtained by PTCD Sample obtained for culture after seventh day of hospitalization Duration of pretreatment with antibiotic therapy of 17 days OR (95% CI) NS .008 .023 Candida species Mezlocillin-resistant bacteria Univariate analysis Multivariate analysis Univariate analysis Multivariate analysis (OR, 3.2), and high sAST levels (172 IU/L) on admission to the hospital (OR, 2.6). DISCUSSION OR (95% CI) Acknowledgment We thank Vera Doljanskaia for her valid advice on the statistical analysis of this study. (...truncated)