The distribution and antibiotic-resistant characteristics and risk factors of pathogens associated with clinical biliary tract infection in humans

Shayan Chen; Wenbin Lai; Xuejing Song; Jiongtang Lu; Jianxin Liang; Hao Ouyang; Weihua Zheng; Jianjun Chen; Zhenggang Yin; Huimin Li; Yong Zhou

doi:10.3389/fmicb.2024.1404366

The distribution and antibiotic-resistant characteristics and risk factors of pathogens associated with clinical biliary tract infection in humans

Front Microbiol. 2024 May 9:15:1404366. doi: 10.3389/fmicb.2024.1404366. eCollection 2024.

Authors

Shayan Chen^{1

2

3

4}, Wenbin Lai^{1

2}, Xuejing Song^{1

2

3

4}, Jiongtang Lu^{1

2}, Jianxin Liang^{1

2}, Hao Ouyang^{1

2}, Weihua Zheng^{1

2}, Jianjun Chen^{1

2}, Zhenggang Yin^{1

2}, Huimin Li^{1

2}, Yong Zhou^{1

2}

Affiliations

¹ Department of Laboratory Science, Binhaiwan Central Hospital of Dongguan, Guangdong, China.
² Dongguan Key Laboratory of Accurate Etiological Research on the Pathogenesis of Inflammation and Cancer, Guangdong, China.
³ Central Laboratory, Binhaiwan Central Hospital of Dongguan, Guangdong, China.
⁴ Dongguan Key Laboratory of Precision Medicine, Guangdong, China.

Abstract

Introduction: Biliary Infection in patients is a common and important phenomenon resulting in severe complications and high morbidity, while the distributions and drug resistance profiles of biliary bacteria and related risk factors are dynamic. This study explored the characteristics of and risk factors for biliary infection to promote the rational use of antibiotics in clinically.

Methods: Bacterial identification and drug susceptibility testing were completed using the Vitek 2 Compact analysis system. The distribution and antibiotic-resistant characteristics of 3,490 strains of biliary bacteria in patients at Nankai Hospital from 2019 to 2021 were analyzed using Whonet 5.6 and SPSS 26.0 software. We then retrospectively analyzed the clinical data and risk factors associated with 2,340 strains of Gram-negative bacilli, which were divided into multidrug-resistant bacteria (1,508 cases) and non-multidrug-resistant bacteria (832 cases) by a multivariate Cox regression model.

Results and discussion: A total of 3,490 pathogenic bacterial strains were isolated from bile samples, including 2,340 (67.05%) Gram-negative strains, 1,029 (29.48%) Gram-positive strains, and 109 (4.56%) fungal strains. The top five pathogenic bacteria were Escherichia coli, Klebsiella pneumoniae, Enterococcus faecium, Enterococcus faecalis, and Pseudomonas aeruginosa. The rate of Escherichia coli resistance to ciprofloxacin increased (p < 0.05), while the resistance to amikacin decreased (p < 0.05). The resistance of Klebsiella pneumoniae to cephalosporins, carbapenems, β-lactamase inhibitors, cephalases, aminoglycosides, and quinolones increased (p < 0.05), and the resistance of Pseudomonas aeruginosa to piperacillin, piperacillin/tazobactam, ticacillin/clavulanic acid, and amicacin declined significantly (p < 0.05). The resistance of Enterococcus faecium to tetracycline increased by year (p < 0.05), and the resistance of Enterococcus faecalis to erythromycin and high-concentration gentamicin declined (p < 0.05). Multivariate logistic regression analysis suggested that the administration of third- or fourth-generation cephalosporins was an independent risk factor for biliary infection. In summary, Gram-negative bacilli were the most common pathogenic bacteria isolated from biliary infection patients, especially Escherichia coli, and the rates and patterns of drug resistance were high and in constant flux; therefore, rational antimicrobial drug use should be carried out considering risk factors.

Keywords: Gram-negative bacteria; biliary pathogens; distribution of bacteria; multidrug-resistant bacteria; risk factors.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by grants 81703846 (SC was the recipient) from the National Science Foundation of China (NSFC), Dongguan Science and Technology of Social Development Program 20231800940062 (SC was the recipient), 20231800937142 (JLi was the recipient), 20231800904242 (XS was the recipient), and 20231800904232 (JLu was the recipient), and grant BS2023001 (SC was its recipient) from the Doctoral Research Foundation of Binhaiwan Central Hospital in Dongguan, Guangdong Province. SC was a recipient of the First Batch of Young Medical Professionals award by the 2018 Tianjin Health Commission.