Duct Infections Research Articles

Bacteriological and Antimicrobial Susceptibility Profile in Biliary Tract Infections: A Retrospective Study

Introduction In the past few years, although there has been no change in the bacteriological profile of organisms responsible for biliary tract infections (BTIs), changes in the drug susceptibility pattern of these organisms have been reported. Material and Methods We planned a retrospective study to evaluate the microbiological profile and antibiotic susceptibility patterns of isolates from patients with BTI.The study was conducted in the Department of Microbiology over a period of 1 year. We recorded the culture positivity rates, organisms identified, and the pattern of antibiotic susceptibility. Results Out of 226 bile samples received, 60.2% samples were found to be culture positive. Most of the patients were older than 40 years. Hypertension (33.1%), diabetes (28.7%), and cardiovascular diseases (8.1%) were the common underlying diseases. Common patient symptoms were abdominal pain (77.89%), jaundice (42.24%), and fever (41.52%). Cholangitis was present in 20.6% patients. Cholelithiasis or choledocholithiasis was the most common underlying etiology (39%). A total of 142 isolates were obtained, with most patients with a predominance of gram-negative isolates. Tigecycline and aminoglycosides were found to be effective against gram-negative isolates with a susceptibility of 93.4 and 95.7%, respectively. Of the gram-negative isolates, approximately 70% were multidrug resistant (MDR), with approximately 80 and 75% being extended spectrum beta-lactamases (ESBLs) and carbapenemase producers, respectively. Enterococci were 100% susceptible to linezolid and 25% of these were vancomycin-resistant enterococci (VRE). Conclusion In summary, the predominant bacteria in our study were gram-negative bacteria that showed increased resistance to cephalosporins and carbapenems. This makes the treatment of bile duct infections increasingly difficult. A comprehensive analysis of the bacterial distribution and drug resistance profiles in patients with BTIs helps physicians to make better antibiotic policies for empiric treatment.

Evaluation of Blood and Biliary Drainage Cultures and Mortality after Percutaneous Transhepatic Biliary Drainage Procedure

Introduction: Bacteremia and bile duct infection following percutaneous transhepatic biliary drainage (PTBD) are severe complications. Thus, the aim of this study was to investigate the risk factors of mortality and to evaluate the differences between blood and biliary drainage culture positive patients after PTBD. Materials and Methods: This is a retrospective study of 90 patients without any signs of infection prior to the PTBD procedures. Of these patients, we further divided them into three groups based on culture results: 1) first group was only bacteremic, 2) second group was only bile drainage culture-positive, and 3) third group was both bacteremic and bile drainage culture-positive. We compared clinical and laboratory parameters between these three groups and also evaluated the culture results in a high-resistance setting. Results: There were 90 patients who developed bacteremia, bile duct infections or both. In the laboratory findings, bacteremic patients showed significantly higher serum level of alanine aminotransferase (ALT) (p=0.001). Elevated neutrophil counts, lipase levels and carbapenem-resistant isolates were found to be the independent risk factors for 30-day mortality after PTBD. (p=0.01, p=0.01, and p=0.04, respectively). Gram-negative organisms were present in 71.2% of the cases; Escherichia coli was the most common species (28.1%) followed by Enterococcus faecium (18.1%), Klebsiella pneumoniae (15.8%) and Pseudomonas aeruginosa (9.9%). 51 (41.8%) of the cultured gram-negative bacteria were extended spectrum beta-lactamases positive and carbapenem resistance was found in 27 (15.8%) isolates. Conclusion: Elevated ALT level was only difference between three groups. Therefore, bacteremic and bile culture positive patients should be treated with the same care. Elevated neutrophil counts, lipase levels and carbapenem-resistant isolates were the independent risk factors for mortality. Finally, the choice of antibiotic prophylaxis should be reviewed according to the antimicrobial resistance profiles.

Bacterial Culture of Tear Duct Infections Secondary to Congenital Nasolacrimal Duct Obstructions.

Purpose To investigate the microbial profile of congenital nasolacrimal duct obstruction (CNLDO) in Chinese children. Methods We retrospectively reviewed the medical records of 330 consecutive children (330 eyes) who were diagnosed with tear duct infections secondary to CNLDO and were admitted to the Children's Hospital of Fudan University from January 2013 to January 2020. Bacterial cultures were grown from tear duct samples of each patient. Samples from conjunctival secretions were cultivated on blood or chocolate agar. Clinically significant bacterial growth was reported. Results Of the 330 eyes considered, 62.7% (207/330) were associated with positive bacterial cultures. A total of 223 isolates were detected from 207 culture-positive eyes. Among the 223 isolates, 52.0% (116/223) were Gram-positive bacteria and 47.1% (105/223) were Gram-negative bacteria. The most prevalent Gram-positive bacteria were Streptococcus viridans (67 isolates, 30%), followed by Staphylococcus aureus (36 isolates, 16.1%) and Streptococcus pneumoniae (5 isolates, 2.2%). The most prevalent Gram-negative bacteria were Neisseria (nonpathogenic) (25 isolates, 11.2%), followed by Escherichia coli (16 isolates, 7.2%) and Haemophilus influenzae (16 eyes, 7.2%). Antibiotic susceptibility test results suggested that both Gram-positive and Gram-negative bacteria were highly sensitive to most of the tested antibiotics. Conclusions S. viridans and S. aureus are the most prevalent bacteria in tear duct infections secondary to CNLDO. Broad-spectrum antibacterial eye drops are suggested as empirical antibiotic treatments.

The Role of Bacterial Etiology in the Tear Duct Infections Secondary to Congenital Nasolacrimal Duct Obstructions.

To define the microbiological features of dacryocystitis in childhood. Patients with dacryocystitis secondary to CNLDO between 2017 and 2019 in Izmir, Turkey were included in the study. Inclusion criteria of the study were: mucopurulent secretion, being under 4 years old and not having received prior antibiotic treatment. Samples from secretion were cultivated in sheep blood agar, eosin methylene blue, and chocolate agar. Reproduction was checked intermittently. Clinically significant growths were reported. Seventy patients with dacryocystitis secondary to CNLDO were included in the study. Sixty percent of patients were female (n = 42) and 40% (n = 28) percent of patients were male. The average age of participants was 2.09 ± 0.68 (1-3) years old. Positive bacterial proliferation results were noted in 20 patients (28.6%). Eighty percent (n = 16) of culture-positive bacterias were gram-negative bacterias and 20% (4) were gram-positive bacterias. Twenty percent of culture-positive bacterias were aerobic and 80% were facultative bacterias. The most common bacteria seen in culture specimen was Haemophilus 40% (Haemophilus haemolyticus [20%] and Haemophilus influenzae [20%]). Gram-negative organisms especially Haemophilus were most prevalent. These findings could be helpful for antibiotic selection.

Bile duct infections with multidrug resistant microorganisms in pancreatic surgery

Bile duct infections with multidrug resistant microorganisms in pancreatic surgery

Bile duct infections with multidrug resistant microorganisms in pancreatic surgery

Background: Preoperative biliary drainage (PBD) causes bacteribilia and increases the risk for infectious complications. Therefore, PBD should be avoided. Nonetheless, even in pancreatic centers more than 50 % of patients undergo PBD before a surgeon is involved. Methods: To present the current situation at a high volume pancreatic center in Germany we retrospectively reviewed 1000 consecutive intraoperative bile duct cultures that were taken after bile duct transection during pancreatic surgery. Results: During a period of nine years 1004 patients had a bile duct transection during pancreatic surgery (pancreatic head resection n=710; palliative hepaticojejunostomy n=294). An infected bile duct culture was found in 61,5 % (617/1004). The most frequent microorganisms were enterococcus spp. in 37,8 % (380/1004). Multidrug resistant microorganisms with resistance against at least three antibiotic classes were present in 24,6 % (247/1004). Among patients with bacteribilia with resistant microorganisms the rate of wound infections was 12,6 % (31/247), vs. 4,5 % (34/757) among the other patients (p ≤ 0.001). Conclusion: Today pancreatic surgeons must be aware, that more than 50 % of patients who undergo surgery for periampullary lesions have infected bile. Twenty-five percent have bacteribilia with resistant microorganisms, which increases the risk for wound infections. Surgeons must adjust their antibiotic treatment according to the hospital specific surveillance data to reduce the risk for wound infections.

Encapsulation of Antifungals in Micelles Protects Candida albicans during Gall-Bladder Infection.

Candida albicans is a dimorphic fungus that colonizes human mucosal surfaces with the potential to cause life-threatening invasive candidiasis. Studies on systemic candidiasis in a murine infection model using in vivo real-time bioluminescence imaging revealed persistence of C. albicans in the gall bladder under antifungal therapy. Preliminary analyses showed that bile conferred resistance against a wide variety of antifungals enabling survival in this cryptic host niche. Here, bile and its components were studied for their ability to reduce antifungal efficacy in order to elucidate the underlying mechanism of protection. While unconjugated bile salts were toxic to C. albicans, taurine, or glycine conjugated bile salts were well tolerated and protective against caspofungin and amphotericin B when exceeding their critical micellar concentration. Microarray experiments indicated that upregulation of genes generally known to mediate antifungal protection is not involved in the protection process. In contrast, rhodamine 6G and crystal violet in- and efflux experiments indicated encapsulation of antifungals in micelles, thereby reducing their bioavailability. Furthermore, farnesol sensing was abolished in the presence of conjugated bile salts trapping C. albicans cells in the hyphal morphology. This suggests that bioavailability of amphiphilic and hydrophobic compounds is reduced in the presence of bile. In contrast, small and hydrophilic molecules, such as cycloheximide, flucytosine, or sodium azide kept their antifungal properties. We therefore conclude that treatment of gall bladder and bile duct infections is hampered by the ability of bile salts to encapsulate antifungals in micelles. As a consequence, treatment of gall bladder or bile duct infections should favor the use of small hydrophilic drugs that are not solubilised in micelles.

Resolution of biliary stricture after living donor liver transplantation in a child by percutaneous trans-hepatic cholangiography and drainage: a case report

IntroductionIntra-hepatic cholestasis arising from biliary strictures is a frequent complication in pediatric patients after liver transplantation. Minimally invasive procedures such as percutaneous drainage placement and balloon dilation are the preferred diagnostic and therapeutic modalities.Case presentationWe report the case of a 12-month-old Caucasian boy with biliary atresia who was initially treated with hepatoportoenterostomy. In the following months, he developed biliary cirrhosis, accompanied by cystic bile retention, recurrent bile duct infections and malabsorption. Six months after the initial surgical intervention, he underwent living donor liver transplantation. Within two months, the hepatico-jejunostomy became occluded leading to progressive intra-hepatic cholestasis. Under sonographic guidance, external drainage of bile was accomplished by percutaneous trans-hepatic cholangiography and drainage. In total, our patient underwent 12 interventions under general anesthesia until balloon dilatation of the hepatico-jejunostomy was successfully performed. Finally, our patient’s general condition improved and he gained weight.ConclusionsMinimally invasive techniques are preferred to surgical revisions and justify even multiple attempts. Interventions under general anesthesia, though not without risks, are still reasonable. Co-operation with parents and multidisciplinary approach to complication management by the involved surgeon, radiologist, pediatrician and anesthesiologist are important.

Immunosuppression, liver injury and post‐transplant HCV recurrence

Hepatitis C virus (HCV) infection is a major cause for liver transplantation worldwide. Still, HCV re-infection of the graft occurs in almost all cases. Most liver transplant recipients experience episodes of graft hepatitis associated with fibrosis progression and graft failure. Clinical management of graft hepatitis can be challenging as in addition to rejection and HCV-induced hepatitis various other factors might be involved including toxic liver injury, steatohepatitis, ischaemic bile duct lesions or infections with other pathogens. Treatment options are often contradictory for different causes of graft hepatitis, and the role of distinct immunosuppressive drugs has been discussed controversially. Corticosteroids increase the infectivity of HCV by altering expression levels of entry factors and other immunosuppressive agents may have diverse effects on HCV replication and fibrosis progression. Interferon alpha-therapy of hepatitis C shows limited efficacy and tolerability in liver transplant recipients and may also cause rejection. In this review we summarize the current knowledge on mechanisms of liver injury in post-transplant hepatitis C, discuss the pros and cons of immunosuppressive agents in this specific setting and describe potential novel approaches to prevent HCV reinfection.

Letter to the Editor

Letter to the Editor

Prevalence and seasonal incidence of larval and adult cestode infections of sheep and goats in eastern Ethiopia

A study on the prevalence and seasonal incidence of cestode parasite infections of sheep and goats was carried out in eastern Ethiopia for 2 years (May 2003-April 2005). During this period, viscera including liver, lungs, heart, kidneys and the gastro-intestinal tract were collected from 655 sheep and 632 goats slaughtered at four abattoirs located in the towns of Haramaya, Harar, Dire Dawa and Jijiga. At the abattoirs the abdominal, thoracic and pelvic cavities as well as the muscle surfaces of all animals were visually examined for the presence of larval (cystic) stages of cestode parasites. The viscera were transported within 24 h to the parasitology laboratory of Haramaya University and were examined for larval and adult cestodes following standard procedures. The most prevalent metacestodes (larval cestodes) were Cysticercus ovis (Taenia ovis), Cysticercus tenuicollis (T. hydatigena) and hydatid cysts (Echinococcus granulosus). In sheep, the overall prevalence was 26% for C. ovis, 79% for C. tenuicollis, and 68% for hydatid cysts. Similarly, for goats, the corresponding prevalence was 22%, 53% and 65%, respectively. The difference between sheep and goats in prevalence of C. tenuicollis was significant. The high prevalence of hydatid cysts in both sheep and goats indicates that cystic echinococcosis/hydatidosis is a public health problem in these regions which requires implementation of control measures, including public health education, strict meat inspection and control of stray dogs. The results of the survey also implies that infections of small ruminants with these metacestodes are responsible for condemnation of substantial quantities of affected organs and muscles and therefore of direct economic importance. Intestinal infections with adult tapeworms of Moniezia expansa, Avitellina centripunctata and Stilesia globipunctata, and bile duct infections with Stilesia hepatica were also common in both sheep and goats. In sheep, the overall prevalence of these tapeworms were 61%, 20%, 24% and 39%, respectively. Similarly, the overall prevalence of these parasites in goats was 53%, 21%, 27% and 36%, respectively.

Involvement of Breast Cancer Resistance Protein (ABCG2) in the Biliary Excretion Mechanism of Fluoroquinolones

Fluoroquinolones are effective antibiotics for the treatment of bile duct infections. It has been shown that the biliary excretion of grepafloxacin is partly accounted for by multidrug resistance-associated protein 2 (MRP2/ABCC2), whereas neither MRP2 nor P-glycoprotein is involved in the biliary excretion of ulifloxacin. In the present study, we examined the involvement of breast cancer resistance protein (BCRP/ABCG2) in the biliary excretion of fluoroquinolones (grepafloxacin, ulifloxacin, ciprofloxacin, and ofloxacin). In Madin-Darby canine kidney II cells expressing human BCRP or mouse Bcrp, the basal-to-apical transport of grepafloxacin and ulifloxacin was greater than that of the mock control, which was inhibited by a BCRP inhibitor, 3-(6-isobutyl-9-methoxy-1,4-dioxo-1,2,3,4,6,7,12,12a-octahydropyrazino[1',2':1,6]pyrido[3,4-b]indol-3-yl)-propionic acid tert-butyl ester (Ko143). Plasma and bile concentrations of fluoroquinolones were determined in wild-type and Bcrp(-/-) mice after i.v. bolus injection. The cumulative biliary excretion of fluoroquinolones was significantly reduced in Bcrp(-/-) mice, resulting in a reduction of the biliary excretion clearances to 86, 50, 40, and 16 of the control values, for ciprofloxacin, grepafloxacin, ofloxacin, and ulifloxacin, respectively. Preinfusion of sulfobromophthalein significantly inhibited the biliary excretion of grepafloxacin in Bcrp(-/-) mice. There was no change in the tissue/plasma concentration ratios of fluoroquinolones in the liver or brain, whereas those in the kidney were increased 3.6- and 1.5-fold for ciprofloxacin and grepafloxacin, respectively, in Bcrp(-/-) mice but were unchanged for ofloxacin and ulifloxacin. The present study shows that BCRP mediates the biliary excretion of fluoroquinolones and suggests that it is also involved in the tubular secretion of ciprofloxacin and grepafloxacin.

Thyroglossal duct infections and surgical outcomes

Purpose Thyroglossal duct cysts (TGDC) are the most common head and neck congenital anomalies in children and often present as infected neck masses. The authors reviewed their experience with TGDC to determine if preoperative infection was related to postoperative complications, including recurrence and postoperative infection. Methods The medical records of 99 patients undergoing excision of TGDC from January 1991 to July 2002 were reviewed. Factors thought to be associated with recurrence (age, history of infection, drainage, abscess, and operative procedure) were analyzed. Results Ninety-nine patients made up the study group. The mean age at operation was 5.0 years (range, 6 months to 16 years) with a male to female ratio of 1.6:1. TGDC recurred in 12.1% (12 of 99) of these patients. There was no gender difference for those with and without recurrence. The presence of an abscess or cellulitis preoperatively (22 of 99 patients) did not correlate with recurrence (NS). In addition, postoperative infection occurred in 13 of 99 patients and also was independent of preoperative infection. However, postoperative infection clearly was associated with an increased risk of TGDC recurrence. Seven of 87 patients without recurrence had a postoperative infection, whereas 6 of 12 of those who had a recurrence had a postoperative infection ( P < .001). The mean follow-up was 3.7 years and was comparable for the 2 groups (recurrence v. resolution). Twelve patients successfully underwent a second procedure for recurrence. Conclusions In this large series of TGDC, preoperative infection occurred in approximately 1 of 5 patients and was not predictive of recurrence. Although postoperative infection did not correlate with the presence of preoperative infection, it was clearly associated with a statistically significant incidence of recurrent disease.

New therapeutic approaches to type 1 diabetes: from prevention to cellular or gene therapies.

New therapeutic approaches to type 1 diabetes: from prevention to cellular or gene therapies.

Chemotherapy of bile duct infections. VI

Chemotherapy of bile duct infections. VI

Chemotherapy of bile duct infections. VIII

Chemotherapy of bile duct infections. VIII

各種臨床材料から分離された菌株のAminobenzyl, Methylphenylisoxazolyl Penicillinに対する感受性について

各種臨床材料から分離された菌株のAminobenzyl, Methylphenylisoxazolyl Penicillinに対する感受性について

Submasseteric abscess

The role that the fascial spaces play in facial infection has been discussed. The anatomy of fascial spaces of the face and the presence and boundaries of the submasseteric compartment have been outlined. The origin of infection in the submasseteric space and the sequence of events secondary to their infection have been discussed. The relationship of this submasseteric space to the parotid gland has been considered. The differential diagnosis involved in separating an infection of this space from an acute parotitis has been reviewed. Emphasis has been placed on the never previously discussed sialographic findings associated with a submasseteric abscess. Definitive sialographic findings disclosed the presence of a laterally displaced Stensen's duct and secondary infections involvement of the accessory parotid gland. Treatment should be aimed at early incision and drainage.

Synthesis of potential chemotherapeutics in bile duct infections (II)

AbstractIn a previous publication1) the synthesis was described of 3′,3″‐disulphanilylamino‐phenolphthalein as a potential chemotherapeutic for combating infected bile ducts.Below the synthesis is described of mono‐sulphanilylamido‐phenolphthalein, α‐phenyl‐β‐(3‐sulphanilylamido‐4‐hydroxyphenyl)‐propionic acid, and 2‐carboxy‐3′‐sulphanilylamido‐4′‐hydroxybenzophenone. An investigation for informative purposes of the latter two compounds has been made as regards their bacteriological and pharmacological properties.

Synthesis of potential chemotherapeutics in bile duct infections. I

AbstractThe preparation of a chemotherapeutic for combating infections of the bile ducts is described.By coupling of 3′,3″‐diaminophenolphthalein with p‐acetylaminobenzene sulphochloride we obtained 3′,3″‐di‐acetylsulphanilylamidophenolphthalein, which by saponification was transformed into 3′,3″‐di‐sulphanilylamidophenolphthalein. This product was found, both by bacteriological and pharmacological investigation, to possess desirable chemotherapeutic properties.