Microbial profile and antibiotic sensitivity pattern in bile cultures from endoscopic retrograde cholangiography patients

AIM:To identify the frequency of bacterial growth,the most commonly grown bacteria and their antibiotic susceptibility,and risk factors for bacterial colonization in bile collected from patients with different biliary diseases.METHODS:This prospective study was conducted between April 2010 and August 2011.Patients with various biliary disorders were included.Bile was aspirated by placing a single-use,5F,standard sphincterotome catheter into the bile duct before the injection of contrast agent during endoscopic retrograde cholangiopancreaticography (ERCP).Bile specimens were transported to the microbiology laboratory in blood culture bottles within an anaerobic transport system.Bacteria were cultured and identified according to the standard protocol used in our clinical microbiology laboratory.The susceptibilities of the organisms recovered were identified using antimicrobial disks,chosen according to the initial gram stain of the positive cultures.RESULTS:Ninety-one patients (27% male,mean age 53.7 ± 17.5 years,range:17-86 years) were included in the study.The main indication for ERCP was benign biliary disease in 79 patients and malignant disease in 12 patients.The bile culture was positive for bacterial growth in 46 out of 91 (50.5%) patients.The most frequently encountered organisms were Gram-negative bacteria including Escherichia coli (28.2%),Pseudomonas (17.3%) and Stenotrophomonas maltophilia (15.2%).There were no significant differences between patients with malignant and benign disease (58% vs 49%,P = 0.474),patients with acute cholangitis and without acute cholangitis (52.9% vs 50%,P = 0.827),patients who were empirically administered antibiotics before intervention and not administered (51.4% vs 60.7%,P = 0.384),with regard to the bacteriobilia.We observed a large covering spectrum or low resistance to meropenem,amikacin and imipenem.CONCLUSION:We did not find a significant risk factor for bacteriobilia in patients with biliary obstruction.A bile sample for microbiological analysis may become a valuable diagnostic tool as it leads to more accurate selection of antibiotics for the treatment of cholangitis.

Clinical presentation and management of Fasciola hepatica infection:Single-center experience

AIM:To identify the characteristic clinical,laboratory and radiological findings and response to treatment in patients with fascioliasis.METHODS:Patients who were diagnosed with Fasciola hepatica infection were included in this prospective study.Initial clinical,laboratory and radiological findings were recorded.All patients were followed until a complete response was achieved or for 6 mo after treatment discontinuation.RESULTS:Fasciola hepatica infection was diagnosed in 30 patients(24 females;mean age:42.6 years) between January 2008 and February 2011.Twentytwo(73%) patients had hepatic phase fascioliasis,5 patients had biliary phase,and 3 patients had biliary phase associated with acute pancreatitis.Of the 8 patients with biliary phase fascioliasis,2 patients displayed features that overlapped with both hepatic and biliary phase.Abdominal pain and right upper abdominal tenderness were the most prominent signs and symptoms in all patients.Eosinophilia was the most prominent laboratory abnormality in both patients with hepatic and biliary phase(100% and 50%,respectively).Multiple nodular lesions like micro-abscesses on abdominal computerized tomography were the main radiological findings in patients with hepatic phase.Small linear filling defects in the distal choledochus were the main endoscopic retrograde cholangiopancreatography(ERCP) findings in patients with biliary phase.Patients with hepatic phase were treated with triclabendazole alone,and patients with biliary phase were treated with triclabendazole and had live Fasciola hepatica extracted from the bile ducts during ERCP.CONCLUSION:Fasciola hepatica infection should be considered in the differential diagnosis of patients with hepatic or biliary disease and/or acute pancreatitis associated with eosinophilia.

在有非酒精的 steatohepatitis 的病人的增加的骨头矿物质密度

AIM:To determine the relationship between non-alcoholic steatohepatitis(NASH)and bone mineral density(BMD).METHODS:A total of 38 patients(25 males)with a diagnosis of histologically proven NASH and 42 healthy controls(24 males)were enrolled in the study.Demographic features,clinical findings,complete blood count and routine biochemical analysis,as well as adrenal,thyroid and gonadal functions,were recorded.Additionally,intact parathormone,25-OH-vitamin-D3,tumor necrosis factor-α,interleukin-6,interleukin-1,in-sulin-like growth factor-1 and insulin-like growth factor binding protein-3 levels were measured in both groups.Furthermore,lumbar spine and femoral neck BMD of both groups were measured by the dual-energy X-ray absorptiometry(DXA)method.RESULTS:The mean age was 41±12 years in the NASH group and 43±11 years in the control group.Among demographic features,waist circumference was significantly larger in the NASH group compared to the control group(P【0.019).Among laboratory parameters,serum triglyceride(P【0.008),alanine transaminase(P【0.0001),aspartate transaminase(P【0.001),alkaline phosphatase(P【0.016),gamma glutamyl transferase(P【0.0001),ferritin(P【0.001)and 25-OH-vitamin-D3levels(P【0.0001)were significantly higher in the NASH group compared to the control group.Lumbar BMD was significantly higher in the NASH group compared to the control group(1.057±0.119 g/cm2vs 0.941±0.133 g/cm2;P【0.001,respectively).In the NASH group,there was no significant relationship between BMD and fibrosis stage in liver biopsy.CONCLUSION:NASH increases BMD and may be related to an elevated serum 25-OH-vitamin D3 level.