Z Gastroenterol 2017; 55(08): e57-e299
DOI: 10.1055/s-0037-1605091
Kurzvorträge
Leber und Galle
PBC, PSC und AIH: Was müssen wir wissen?: Freitag, 15 September 2017, 08:30 – 09:50, St. Petersburg/Forschungsforum 1
Georg Thieme Verlag KG Stuttgart · New York

In PSC with dominant bile duct stenosis, multi-resistant bacteriobilia is associated with reduced survival

C Rupp
1   Medizinische Universitätsklinik Heidelberg, Medizinische Klinik IV, Heidelberg, Deutschland
2   Universitätsklinikum Heidelberg, Interdisziplinäres Endoskopiezentrum (IEZ), Heidelberg, Deutschland
,
H Salzer
1   Medizinische Universitätsklinik Heidelberg, Medizinische Klinik IV, Heidelberg, Deutschland
,
KA Bode
3   Universitätsklinikum Heidelberg, Medizinische Mikrobiologie und Hygiene, Heidelberg, Deutschland
,
KH Weiss
1   Medizinische Universitätsklinik Heidelberg, Medizinische Klinik IV, Heidelberg, Deutschland
,
W Stremmel
1   Medizinische Universitätsklinik Heidelberg, Medizinische Klinik IV, Heidelberg, Deutschland
,
P Sauer
1   Medizinische Universitätsklinik Heidelberg, Medizinische Klinik IV, Heidelberg, Deutschland
2   Universitätsklinikum Heidelberg, Interdisziplinäres Endoskopiezentrum (IEZ), Heidelberg, Deutschland
,
DN Gotthardt
1   Medizinische Universitätsklinik Heidelberg, Medizinische Klinik IV, Heidelberg, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
02 August 2017 (online)

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    Introduction:

    Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease, characterized by sclerosis and destruction of the biliary system. The course of diseases is often complicated by biliary infections.

    Aims:

    We aimed to analyze the frequency and influence of cholangitis with multi-resistant bacteria in PSC patients.

    Methods:

    Patients who were admitted to our Department during the time period of 1987 and 2015 with well-defined diagnosis of PSC were analyzed in regard to multi-resistant bacteria. Bile cultures were routinely collected during diagnostic and/or therapeutic ERCP.

    Results:

    We identified 20/244 (8.3) patients with multi-resistant bacteriobilia. 8 patients had vancomycin resistant enterococcus (VRE) and 12 had multi-resistant gram negative bacteria (MRGN) in bile culture. Baseline characteristic including laboratory values (AST, ALT, GGT, AP, Bilirubin), age at onset of PSC, concomitant inflammatory bowel disease, overlap with autoimmune hepatitis (AIHOL), dominant stenosis (DS) and Mayo Risk Score (MRS) were not different between both groups. There was no difference in frequency of MR bacteriobilia between patients with or without DS (14/159, 8.8% vs. 6/66, 9.1%; p = 0.8). Kaplan-Meier analysis showed reduced transplantation-free survival in PSC patients with MR bacteriobilia (17.1 vs. 10.8 years; p = 0.012). Stratification for presence of DS revealed reduced survival in presence of MR bacteriobilia only in patients with DS (16.7 vs. 9.6 years; p = 0.001), whereas no influence was detectable in PSC patients without DS (20.7 vs. 17.8 years; p = 0.8). In multivariate analysis, including gender, age, AIHOL, IBD, DS, number of endoscopic interventions, MRS and MR bacteriobilia, only IBD (HR 3.3, 95% CI 1.1 – 11.1; p = 0.04), MRS (HR 1.5, 95% CI 1.1 – 2.1; p = 0.04) and MR bacteriobilia (HR 3.2, 95% CI 1.1 – 9.5; p = 0.03) were independent risk factors for reduced transplantation-free survival.

    Conclusion:

    In PSC patients with dominant stenosis MR bacteriobilia is associated with reduced survival, independent of number of endoscopic interventions. Multi-resistant bacteria may play a role in the progression of PSC. Optimal treatment strategies need to be established in order to achieve eradication of MR bacteria.