A Multipathogen Bile Sample-based PCR Assay Can Guide Empirical Antimicrobial Strategies in Cholestatic Liver Diseases

Overview

Journal J Clin Transl Hepatol

Specialty Gastroenterology

Date 2022 Oct 28

PMID 36304501

Authors

Michael Jahn

Mustafa K Ozcurumez

Sebastian Dolff

Hana Rohn

Dominik Heider

Alexander Dechene

Ali Canbay

Peter M Rath

Antonios Katsounas

Affiliations

Soon will be listed here.

Abstract

Background And Objectives: Polymerase chain reaction (PCR) techniques provide rapid detection of pathogens. This pilot study evaluated the diagnostic utility and clinical impact of multiplex real-time PCR (mRT-PCR, Septi) vs. conventional microbial culture (CMC) in bile samples of patients with chronic cholestatic liver diseases (cCLDs), endoscopic retrograde cholangio-pancreatography (ERCP), and peri-interventional-antimicrobial-prophylaxis (pAP).

Methods: We prospectively collected bile samples from 26 patients for microbiological analysis by CMC and mRT-PCR. Concordance of the results of both methods was determined by Krippendorff's alpha (α) for inter-rater reliability and the Jaccard index of similarity.

Results: mRT-PCR and CMC results were concordant for only (α=0.8406; Jaccard index=0.8181). mRT-PCR detected pathogens in 8/8 cases (100%), CMC in 7/8 (87.5%), and CMC in 5/8 (62.5%) with clinical signs of infection. mRT-PCR, CMC, and CMC had identical detection results in 3/8 (37.5%) with clinical signs of infection (two spp. and one ). The total pathogen count was significantly higher with mRT-PCR than with CMC (62 vs. 31; χ=30.031, <0.001). However, pathogens detected by mRT-PCR were more often susceptible to pAP according to the patient infection/colonization history (PI/CH) and surveillance data for antibiotic resistance in our clinic (DARC). Pathogens identified by mRT-PCR and resistant to pAP by PI/CH and DARC were likely to be clinically relevant.

Conclusions: mRT-PCR in conjunction with CMCs for bile analysis increased diagnostic sensitivity and may benefit infection management in patients with cholestatic diseases. Implementation of mRT-PCR in a bile sample-based diagnostic routine can support more rapid and targeted use of antimicrobial agents in cCLD-patients undergoing ERCP and reduce the rate/length of unnecessary administration of broad-spectrum antibiotics.

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