Etiological Research And Multiplicity Of Malignant Obstructive Jaundice With Biliary Infection

Objective:A retrospective one-center study was conducted to assess the information of bile culture and susceptibility testing special for malignant biliary obstruction and to get the risk factors of biliary system infection after percutaneous transhepatic cholangial drainage (PTCD) in malignant obstructive jaundice (MOJ) patients.Methods:From August2003to September2010,694patients with malignant biliary obstruction received percutaneous transhepatic cholangial drainage (PTCD). Bile specimens were collected during the procedure of PTCD. Collect the information of gender, age, obstruction time,type of primartumor,site of obstruction, drainage style, tumor stage, hemoglobin, phenotype of peripheral blood mononuclear cell (Treg), bilirubin total, direct bilirubin, albumin, Child-Pugh score, and results of bile culture for Logistic multiplicity.Results:There are694patients with malignant biliary obstruction in the study. There were485males and209females in the study with an age range of38-78years (mean62). There was no growth on bile culture in57.1%patients (396/694).42.9%patients had a positive bile culture (298/694) and342strains of microorganism were identified. There were156patients(22.3%,156/694) diagnosed by biliary infection.Gram-positive bacteria account for50.9%(174/342) and Gram-negative bacteria account for41.5%(142/342). No anaerobes were cultured in this research. The most frequent microorganisms were Enterococcus faecalis (12.0%,41/342), Escherichia coli (9.9%,34/342), Klebsiella pneumoniae (8.2%,28/342), Staphylococcus epidermidis (5.6%,19/342), Enterococcus (5.3%,18/342) and Enterobacter cloacae (4.7%,16/342). The rate of beta-lactamase producing Gram-positive bacteria was27.6%(48/174) and the rate of Gram-negative bacteria was19.7%(28/142). The rate of enzyme-producing Escherichia coli was61.8%(21/34). The risk factor of biliary system infection after PTCD include age (x2=4.621,p=0.032)、site of obstruction (x2=17.450,p<0.001)、drainage style (x2=14.452,p<0.001)、tumor stage (x2=4.741,p=0.029)、hemoglobin (x2=3.914 p=0.048), Child-Pugh score (x2=5.491,p=0.019), albumin<30g/L(x2=4.776,p=0.029), phenotype of peripheral blood mononuclear cell (Treg)(x2=5.015,p=0.025), results of bile culture(x2=65.381, p<0.001).And results of Logistic multiplicity is the risk factors were drainage style, Child-Pugh score and results of bile culture.Conclusions:Our findings suggest the bile cultures in malignant biliary obstruction are different from those in Tokyo Guidelines and benign biliary obstruction researches, which indicate antibacterial therapy should be different. The risk factor of biliary system infection after PTCD include age, site of obstruction, drainage style, tumor stage,hemoglobin,Child-Pugh score, phenotype of peripheral blood mononuclear cell (Treg) and results of bile culture. And drainage style, Child-Pugh score and results of bile culture are independent risk factors. Knowledge of the antimicrobial susceptibility data could inform better use of antibiotics for empiric therapy for biliary infection with malignant biliary obstruction.