Epidemiology and Resistance Patterns of Bacterial and Fungal Colonization of Biliary Plastic Stents: A Prospective Cohort Study
Plastic stents used for the treatment of biliary obstruction will become occluded over time due to microbial colonization and formation of biofilms. Treatment of stent-associated cholangitis is often not effective because of inappropriate use of antimicrobial agents or antimicrobial resistance. We a...
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| Veröffentlicht in: | PloS one 2016-05, Vol.11 (5), p.e0155479-e0155479 |
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| creator | Lübbert, Christoph Wendt, Karolin Feisthammel, Jürgen Moter, Annette Lippmann, Norman Busch, Thilo Mössner, Joachim Hoffmeister, Albrecht Rodloff, Arne C |
| description | Plastic stents used for the treatment of biliary obstruction will become occluded over time due to microbial colonization and formation of biofilms. Treatment of stent-associated cholangitis is often not effective because of inappropriate use of antimicrobial agents or antimicrobial resistance. We aimed to assess the current bacterial and fungal etiology of stent-associated biofilms, with particular emphasis on antimicrobial resistance.
Patients with biliary strictures requiring endoscopic stent placement were prospectively enrolled. After the retrieval of stents, biofilms were disrupted by sonication, microorganisms were cultured, and isolates were identified by matrix-associated laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry and/or biochemical typing. Finally, minimum inhibitory concentrations (MICs) were determined for various antimicrobial agents. Selected stents were further analyzed by fluorescence in situ hybridization (FISH).
Among 120 patients (62.5% males, median age 64 years) with biliary strictures (35% malignant, 65% benign), 113 double pigtail polyurethane and 100 straight polyethylene stents were analyzed after a median indwelling time of 63 days (range, 1-1274 days). The stent occlusion rate was 11.5% and 13%, respectively, being associated with a significantly increased risk of cholangitis (38.5% vs. 9.1%, P |
| doi_str_mv | 10.1371/journal.pone.0155479 |
| format | Article |
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Patients with biliary strictures requiring endoscopic stent placement were prospectively enrolled. After the retrieval of stents, biofilms were disrupted by sonication, microorganisms were cultured, and isolates were identified by matrix-associated laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry and/or biochemical typing. Finally, minimum inhibitory concentrations (MICs) were determined for various antimicrobial agents. Selected stents were further analyzed by fluorescence in situ hybridization (FISH).
Among 120 patients (62.5% males, median age 64 years) with biliary strictures (35% malignant, 65% benign), 113 double pigtail polyurethane and 100 straight polyethylene stents were analyzed after a median indwelling time of 63 days (range, 1-1274 days). The stent occlusion rate was 11.5% and 13%, respectively, being associated with a significantly increased risk of cholangitis (38.5% vs. 9.1%, P<0.001). Ninety-five different bacterial and 13 fungal species were detected; polymicrobial colonization predominated (95.8% vs. 4.2%, P<0.001). Enterococci (79.3%), Enterobacteriaceae (73.7%), and Candida spp. (55.9%) were the leading pathogens. Candida species were more frequent in patients previously receiving prolonged antibiotic therapy (63% vs. 46.7%, P = 0.023). Vancomycin-resistant enterococci accounted for 13.7%, extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae with co-resistance to ciprofloxacin accounted for 13.9%, and azole-resistant Candida spp. accounted for 32.9% of the respective isolates.
Enterococci and Candida species play an important role in the microbial colonization of biliary stents. Therefore, empirical antimicrobial treatment of stent-associated cholangitis should be guided toward enterococci, Enterobacteriaceae, streptococci, anaerobes, and Candida. To determine causative pathogens, an accurate microbiological analysis of the extracted stent(s) may be helpful.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0155479</identifier><identifier>PMID: 27171497</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject><![CDATA[Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anaerobes ; Anti-Bacterial Agents - pharmacology ; Anti-Bacterial Agents - therapeutic use ; Antibiotic resistance ; Antibiotics ; Antiinfectives and antibacterials ; Antimicrobial agents ; Antimicrobial resistance ; Bacteria ; Bacteria - drug effects ; Bacteria - growth & development ; Bacteria - isolation & purification ; Bile ; Biliary tract ; Biliary Tract - microbiology ; Biliary Tract - pathology ; Biofilms ; Biofilms - drug effects ; Biofilms - growth & development ; Biology and Life Sciences ; Body Fluids ; Candida ; Child ; Cholangitis ; Ciprofloxacin ; Cohort analysis ; Colonization ; Colony Count, Microbial ; Complications and side effects ; Consortia ; Deoxyribonucleic acid ; DNA ; Drug Resistance, Microbial - drug effects ; Empirical analysis ; Endoscopes ; Endoscopy ; Enterobacteriaceae ; Epidemiology ; Ethics ; Etiology ; Female ; Fluorescence ; Fluorescence in situ hybridization ; Fungi ; Fungi - drug effects ; Fungi - growth & development ; Fungi - isolation & purification ; Gallbladder diseases ; Gastroenterology ; Hospitals ; Humans ; Implants ; Infections ; Infectious diseases ; Ionization ; Klebsiella pneumoniae ; Liver Transplantation ; Maintenance and repair ; Male ; Males ; Mass spectrometry ; Mass spectroscopy ; Medicine and Health Sciences ; Microbial Sensitivity Tests ; Microbiological analysis ; Microbiology ; Microorganisms ; Middle Aged ; Mortality ; Occlusion ; Pathogens ; Patients ; Physiological aspects ; Plastics ; Polyethylene ; Polyethylenes ; Polyurethane ; Polyurethane resins ; Prospective Studies ; Prosthesis-Related Infections - drug therapy ; Prosthesis-Related Infections - epidemiology ; Prosthesis-Related Infections - microbiology ; Research and Analysis Methods ; Rheumatology ; Sonication ; Species ; Stenosis ; Stents ; Stents - adverse effects ; Stents - microbiology ; Stricture ; Studies ; Surgical implants ; Systematic review ; Time Factors ; Transplants & implants ; Typing ; Vancomycin ; Young Adult ; β Lactamase]]></subject><ispartof>PloS one, 2016-05, Vol.11 (5), p.e0155479-e0155479</ispartof><rights>COPYRIGHT 2016 Public Library of Science</rights><rights>2016 Lübbert et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2016 Lübbert et al 2016 Lübbert et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c725t-27d62ec2dcefe104b604f753baf8b513c5ba7c157e25de923280ab99be3df9293</citedby><cites>FETCH-LOGICAL-c725t-27d62ec2dcefe104b604f753baf8b513c5ba7c157e25de923280ab99be3df9293</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4865241/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4865241/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27171497$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Alpini, Gianfranco D.</contributor><creatorcontrib>Lübbert, Christoph</creatorcontrib><creatorcontrib>Wendt, Karolin</creatorcontrib><creatorcontrib>Feisthammel, Jürgen</creatorcontrib><creatorcontrib>Moter, Annette</creatorcontrib><creatorcontrib>Lippmann, Norman</creatorcontrib><creatorcontrib>Busch, Thilo</creatorcontrib><creatorcontrib>Mössner, Joachim</creatorcontrib><creatorcontrib>Hoffmeister, Albrecht</creatorcontrib><creatorcontrib>Rodloff, Arne C</creatorcontrib><title>Epidemiology and Resistance Patterns of Bacterial and Fungal Colonization of Biliary Plastic Stents: A Prospective Cohort Study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Plastic stents used for the treatment of biliary obstruction will become occluded over time due to microbial colonization and formation of biofilms. Treatment of stent-associated cholangitis is often not effective because of inappropriate use of antimicrobial agents or antimicrobial resistance. We aimed to assess the current bacterial and fungal etiology of stent-associated biofilms, with particular emphasis on antimicrobial resistance.
Patients with biliary strictures requiring endoscopic stent placement were prospectively enrolled. After the retrieval of stents, biofilms were disrupted by sonication, microorganisms were cultured, and isolates were identified by matrix-associated laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry and/or biochemical typing. Finally, minimum inhibitory concentrations (MICs) were determined for various antimicrobial agents. Selected stents were further analyzed by fluorescence in situ hybridization (FISH).
Among 120 patients (62.5% males, median age 64 years) with biliary strictures (35% malignant, 65% benign), 113 double pigtail polyurethane and 100 straight polyethylene stents were analyzed after a median indwelling time of 63 days (range, 1-1274 days). The stent occlusion rate was 11.5% and 13%, respectively, being associated with a significantly increased risk of cholangitis (38.5% vs. 9.1%, P<0.001). Ninety-five different bacterial and 13 fungal species were detected; polymicrobial colonization predominated (95.8% vs. 4.2%, P<0.001). Enterococci (79.3%), Enterobacteriaceae (73.7%), and Candida spp. (55.9%) were the leading pathogens. Candida species were more frequent in patients previously receiving prolonged antibiotic therapy (63% vs. 46.7%, P = 0.023). Vancomycin-resistant enterococci accounted for 13.7%, extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae with co-resistance to ciprofloxacin accounted for 13.9%, and azole-resistant Candida spp. accounted for 32.9% of the respective isolates.
Enterococci and Candida species play an important role in the microbial colonization of biliary stents. Therefore, empirical antimicrobial treatment of stent-associated cholangitis should be guided toward enterococci, Enterobacteriaceae, streptococci, anaerobes, and Candida. To determine causative pathogens, an accurate microbiological analysis of the extracted stent(s) may be helpful.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anaerobes</subject><subject>Anti-Bacterial Agents - pharmacology</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotic resistance</subject><subject>Antibiotics</subject><subject>Antiinfectives and antibacterials</subject><subject>Antimicrobial agents</subject><subject>Antimicrobial resistance</subject><subject>Bacteria</subject><subject>Bacteria - drug effects</subject><subject>Bacteria - growth & development</subject><subject>Bacteria - isolation & purification</subject><subject>Bile</subject><subject>Biliary tract</subject><subject>Biliary Tract - microbiology</subject><subject>Biliary Tract - pathology</subject><subject>Biofilms</subject><subject>Biofilms - drug effects</subject><subject>Biofilms - growth & development</subject><subject>Biology and Life Sciences</subject><subject>Body Fluids</subject><subject>Candida</subject><subject>Child</subject><subject>Cholangitis</subject><subject>Ciprofloxacin</subject><subject>Cohort analysis</subject><subject>Colonization</subject><subject>Colony Count, Microbial</subject><subject>Complications and side effects</subject><subject>Consortia</subject><subject>Deoxyribonucleic acid</subject><subject>DNA</subject><subject>Drug Resistance, Microbial - drug effects</subject><subject>Empirical analysis</subject><subject>Endoscopes</subject><subject>Endoscopy</subject><subject>Enterobacteriaceae</subject><subject>Epidemiology</subject><subject>Ethics</subject><subject>Etiology</subject><subject>Female</subject><subject>Fluorescence</subject><subject>Fluorescence in situ hybridization</subject><subject>Fungi</subject><subject>Fungi - drug effects</subject><subject>Fungi - growth & development</subject><subject>Fungi - isolation & purification</subject><subject>Gallbladder diseases</subject><subject>Gastroenterology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Implants</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Ionization</subject><subject>Klebsiella pneumoniae</subject><subject>Liver Transplantation</subject><subject>Maintenance and repair</subject><subject>Male</subject><subject>Males</subject><subject>Mass spectrometry</subject><subject>Mass spectroscopy</subject><subject>Medicine and Health Sciences</subject><subject>Microbial Sensitivity Tests</subject><subject>Microbiological analysis</subject><subject>Microbiology</subject><subject>Microorganisms</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Occlusion</subject><subject>Pathogens</subject><subject>Patients</subject><subject>Physiological aspects</subject><subject>Plastics</subject><subject>Polyethylene</subject><subject>Polyethylenes</subject><subject>Polyurethane</subject><subject>Polyurethane resins</subject><subject>Prospective Studies</subject><subject>Prosthesis-Related Infections - drug therapy</subject><subject>Prosthesis-Related Infections - epidemiology</subject><subject>Prosthesis-Related Infections - microbiology</subject><subject>Research and Analysis Methods</subject><subject>Rheumatology</subject><subject>Sonication</subject><subject>Species</subject><subject>Stenosis</subject><subject>Stents</subject><subject>Stents - adverse effects</subject><subject>Stents - microbiology</subject><subject>Stricture</subject><subject>Studies</subject><subject>Surgical implants</subject><subject>Systematic review</subject><subject>Time Factors</subject><subject>Transplants & implants</subject><subject>Typing</subject><subject>Vancomycin</subject><subject>Young Adult</subject><subject>β Lactamase</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk01vEzEQhlcIREvhHyBYCQnBIcEf6_WaA1KJWohUqVELXC2vdzZx5djp2lsRLvx1vE1aJaiHygeP7Gdej-cjy15jNMaU409Xvu-csuOVdzBGmLGCiyfZIRaUjEqC6NMd-yB7EcIVQoxWZfk8OyAcc1wIfpj9PVmZBpbGWz9f58o1-QUEE6JyGvKZihE6F3Lf5l-VTrZR9hY67d08mZPk5swfFY13t5CxRnXrfGZViEbnlxFcDJ_z43zW-bACHc0NJK-F72K67Jv1y-xZq2yAV9v9KPt5evJj8n10dv5tOjk-G2lOWBwR3pQENGk0tIBRUZeoaDmjtWqrmmGqWa24xowDYQ0IQkmFVC1EDbRpBRH0KHu70V1ZH-Q2d0FiXlWsoJiUiZhuiMarK7nqzDL9RHpl5O2B7-ZSdelTFiSQFoTSDW5RVSBdK4aamnCtQIu0Da992b7W10tIQbvYKbsnun_jzELO_Y0sqpKRAieBD1uBzl_3EKJcmqDBWuXA90PcomAIl4g-Aq1EIZLmoPruP_ThRGypVGGQxrU-hagHUXlcMEo5ooQlavwAldbQTTr1ZGvS-Z7Dxz2HxET4HeeqD0FOLy8ez57_2mff77ALUDYugrf90JNhHyw2oE69GDpo7-uBkRxG6i4bchgpuR2p5PZmt5b3TnczRP8BKq4dPg</recordid><startdate>20160512</startdate><enddate>20160512</enddate><creator>Lübbert, Christoph</creator><creator>Wendt, Karolin</creator><creator>Feisthammel, Jürgen</creator><creator>Moter, Annette</creator><creator>Lippmann, Norman</creator><creator>Busch, Thilo</creator><creator>Mössner, Joachim</creator><creator>Hoffmeister, Albrecht</creator><creator>Rodloff, Arne C</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20160512</creationdate><title>Epidemiology and Resistance Patterns of Bacterial and Fungal Colonization of Biliary Plastic Stents: A Prospective Cohort Study</title><author>Lübbert, Christoph ; Wendt, Karolin ; Feisthammel, Jürgen ; Moter, Annette ; Lippmann, Norman ; Busch, Thilo ; Mössner, Joachim ; Hoffmeister, Albrecht ; Rodloff, Arne C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c725t-27d62ec2dcefe104b604f753baf8b513c5ba7c157e25de923280ab99be3df9293</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anaerobes</topic><topic>Anti-Bacterial Agents - pharmacology</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotic resistance</topic><topic>Antibiotics</topic><topic>Antiinfectives and antibacterials</topic><topic>Antimicrobial agents</topic><topic>Antimicrobial resistance</topic><topic>Bacteria</topic><topic>Bacteria - drug effects</topic><topic>Bacteria - growth & development</topic><topic>Bacteria - isolation & purification</topic><topic>Bile</topic><topic>Biliary tract</topic><topic>Biliary Tract - microbiology</topic><topic>Biliary Tract - pathology</topic><topic>Biofilms</topic><topic>Biofilms - drug effects</topic><topic>Biofilms - growth & development</topic><topic>Biology and Life Sciences</topic><topic>Body Fluids</topic><topic>Candida</topic><topic>Child</topic><topic>Cholangitis</topic><topic>Ciprofloxacin</topic><topic>Cohort analysis</topic><topic>Colonization</topic><topic>Colony Count, Microbial</topic><topic>Complications and side effects</topic><topic>Consortia</topic><topic>Deoxyribonucleic acid</topic><topic>DNA</topic><topic>Drug Resistance, Microbial - drug effects</topic><topic>Empirical analysis</topic><topic>Endoscopes</topic><topic>Endoscopy</topic><topic>Enterobacteriaceae</topic><topic>Epidemiology</topic><topic>Ethics</topic><topic>Etiology</topic><topic>Female</topic><topic>Fluorescence</topic><topic>Fluorescence in situ hybridization</topic><topic>Fungi</topic><topic>Fungi - drug effects</topic><topic>Fungi - growth & development</topic><topic>Fungi - isolation & purification</topic><topic>Gallbladder diseases</topic><topic>Gastroenterology</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Implants</topic><topic>Infections</topic><topic>Infectious diseases</topic><topic>Ionization</topic><topic>Klebsiella pneumoniae</topic><topic>Liver Transplantation</topic><topic>Maintenance and repair</topic><topic>Male</topic><topic>Males</topic><topic>Mass spectrometry</topic><topic>Mass spectroscopy</topic><topic>Medicine and Health Sciences</topic><topic>Microbial Sensitivity Tests</topic><topic>Microbiological analysis</topic><topic>Microbiology</topic><topic>Microorganisms</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Occlusion</topic><topic>Pathogens</topic><topic>Patients</topic><topic>Physiological aspects</topic><topic>Plastics</topic><topic>Polyethylene</topic><topic>Polyethylenes</topic><topic>Polyurethane</topic><topic>Polyurethane resins</topic><topic>Prospective Studies</topic><topic>Prosthesis-Related Infections - drug therapy</topic><topic>Prosthesis-Related Infections - epidemiology</topic><topic>Prosthesis-Related Infections - microbiology</topic><topic>Research and Analysis Methods</topic><topic>Rheumatology</topic><topic>Sonication</topic><topic>Species</topic><topic>Stenosis</topic><topic>Stents</topic><topic>Stents - adverse effects</topic><topic>Stents - microbiology</topic><topic>Stricture</topic><topic>Studies</topic><topic>Surgical implants</topic><topic>Systematic review</topic><topic>Time Factors</topic><topic>Transplants & implants</topic><topic>Typing</topic><topic>Vancomycin</topic><topic>Young Adult</topic><topic>β Lactamase</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lübbert, Christoph</creatorcontrib><creatorcontrib>Wendt, Karolin</creatorcontrib><creatorcontrib>Feisthammel, Jürgen</creatorcontrib><creatorcontrib>Moter, Annette</creatorcontrib><creatorcontrib>Lippmann, Norman</creatorcontrib><creatorcontrib>Busch, Thilo</creatorcontrib><creatorcontrib>Mössner, Joachim</creatorcontrib><creatorcontrib>Hoffmeister, Albrecht</creatorcontrib><creatorcontrib>Rodloff, Arne C</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - Academic</collection><collection>ProQuest Engineering Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Agricultural Science Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Engineering Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials Science Collection</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lübbert, Christoph</au><au>Wendt, Karolin</au><au>Feisthammel, Jürgen</au><au>Moter, Annette</au><au>Lippmann, Norman</au><au>Busch, Thilo</au><au>Mössner, Joachim</au><au>Hoffmeister, Albrecht</au><au>Rodloff, Arne C</au><au>Alpini, Gianfranco D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Epidemiology and Resistance Patterns of Bacterial and Fungal Colonization of Biliary Plastic Stents: A Prospective Cohort Study</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2016-05-12</date><risdate>2016</risdate><volume>11</volume><issue>5</issue><spage>e0155479</spage><epage>e0155479</epage><pages>e0155479-e0155479</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Plastic stents used for the treatment of biliary obstruction will become occluded over time due to microbial colonization and formation of biofilms. Treatment of stent-associated cholangitis is often not effective because of inappropriate use of antimicrobial agents or antimicrobial resistance. We aimed to assess the current bacterial and fungal etiology of stent-associated biofilms, with particular emphasis on antimicrobial resistance.
Patients with biliary strictures requiring endoscopic stent placement were prospectively enrolled. After the retrieval of stents, biofilms were disrupted by sonication, microorganisms were cultured, and isolates were identified by matrix-associated laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry and/or biochemical typing. Finally, minimum inhibitory concentrations (MICs) were determined for various antimicrobial agents. Selected stents were further analyzed by fluorescence in situ hybridization (FISH).
Among 120 patients (62.5% males, median age 64 years) with biliary strictures (35% malignant, 65% benign), 113 double pigtail polyurethane and 100 straight polyethylene stents were analyzed after a median indwelling time of 63 days (range, 1-1274 days). The stent occlusion rate was 11.5% and 13%, respectively, being associated with a significantly increased risk of cholangitis (38.5% vs. 9.1%, P<0.001). Ninety-five different bacterial and 13 fungal species were detected; polymicrobial colonization predominated (95.8% vs. 4.2%, P<0.001). Enterococci (79.3%), Enterobacteriaceae (73.7%), and Candida spp. (55.9%) were the leading pathogens. Candida species were more frequent in patients previously receiving prolonged antibiotic therapy (63% vs. 46.7%, P = 0.023). Vancomycin-resistant enterococci accounted for 13.7%, extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae with co-resistance to ciprofloxacin accounted for 13.9%, and azole-resistant Candida spp. accounted for 32.9% of the respective isolates.
Enterococci and Candida species play an important role in the microbial colonization of biliary stents. Therefore, empirical antimicrobial treatment of stent-associated cholangitis should be guided toward enterococci, Enterobacteriaceae, streptococci, anaerobes, and Candida. To determine causative pathogens, an accurate microbiological analysis of the extracted stent(s) may be helpful.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>27171497</pmid><doi>10.1371/journal.pone.0155479</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2016-05, Vol.11 (5), p.e0155479-e0155479 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1788543126 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adolescent Adult Aged Aged, 80 and over Anaerobes Anti-Bacterial Agents - pharmacology Anti-Bacterial Agents - therapeutic use Antibiotic resistance Antibiotics Antiinfectives and antibacterials Antimicrobial agents Antimicrobial resistance Bacteria Bacteria - drug effects Bacteria - growth & development Bacteria - isolation & purification Bile Biliary tract Biliary Tract - microbiology Biliary Tract - pathology Biofilms Biofilms - drug effects Biofilms - growth & development Biology and Life Sciences Body Fluids Candida Child Cholangitis Ciprofloxacin Cohort analysis Colonization Colony Count, Microbial Complications and side effects Consortia Deoxyribonucleic acid DNA Drug Resistance, Microbial - drug effects Empirical analysis Endoscopes Endoscopy Enterobacteriaceae Epidemiology Ethics Etiology Female Fluorescence Fluorescence in situ hybridization Fungi Fungi - drug effects Fungi - growth & development Fungi - isolation & purification Gallbladder diseases Gastroenterology Hospitals Humans Implants Infections Infectious diseases Ionization Klebsiella pneumoniae Liver Transplantation Maintenance and repair Male Males Mass spectrometry Mass spectroscopy Medicine and Health Sciences Microbial Sensitivity Tests Microbiological analysis Microbiology Microorganisms Middle Aged Mortality Occlusion Pathogens Patients Physiological aspects Plastics Polyethylene Polyethylenes Polyurethane Polyurethane resins Prospective Studies Prosthesis-Related Infections - drug therapy Prosthesis-Related Infections - epidemiology Prosthesis-Related Infections - microbiology Research and Analysis Methods Rheumatology Sonication Species Stenosis Stents Stents - adverse effects Stents - microbiology Stricture Studies Surgical implants Systematic review Time Factors Transplants & implants Typing Vancomycin Young Adult β Lactamase |
| title | Epidemiology and Resistance Patterns of Bacterial and Fungal Colonization of Biliary Plastic Stents: A Prospective Cohort Study |
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