Abstract

SINGH, R et al. Microbiological analysis and predictors of gallbladder infection with antimicrobial susceptibility patterns in an HIV setting. SAMJ, S. Afr. med. j. [online]. 2023, vol.113, n.6, pp.1236-1242. ISSN 2078-5135.  http://dx.doi.org/10.7196/SAMJ.2023.v113i6.442.

BACKGROUND: South Africa (SA) has a high prevalence of HIV infection, which has been shown to affect the prevalence and severity of other infections and of sepsis, particularly in gallbladder (GB) disease. Empirical antimicrobial (EA) therapy for acute cholecystitis is based largely on bacterial colonisation of bile (bacteriobilia) and antimicrobial susceptibility patterns (antibiograms) obtained from the developed world, where the prevalence of HIV infection is very low. In an era of ever-increasing antimicrobial resistance, it is of vital importance to monitor and update local antibiograms OBJECTIVES: Owing to the paucity of data available locally to guide treatment, our objectives were to examine GB bile for bacteriobilia and to assess antibiograms in a setting with a high prevalence of HIV infection, in order to determine the need for review of our local antimicrobial policies for both EA therapy for GB infections and preoperative antimicrobial prophylaxis (PAP) for laparoscopic cholecystectomy (LC METHODS: A retrospective observational descriptive study was undertaken at King Edward VIII Hospital, Durban, SA. Hospital records were reviewed for all patients undergoing LC over a 3-year period. GB bacteriobilia and antibiograms were assessed and compared between people living with HIV (PLWH) and people who were HIV uninfected (HIV-U). The preoperative parameters of age, endoscopic retrograde cholangiopancreatography (ERCP), procalcitonin (PCT), C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) were assessed as predictors for bacteriobilia. Statistical analyses were performed using R for statistical computing, andp-values <0.05 were considered statistically significant RESULTS: There were no differences in bacteriobilia or antibiograms between PLWH and HIV-U. There was >30% resistance to amoxicillin/ clavulanate and cephalosporins. Aminoglycoside-based therapy had good susceptibility patterns, while carbapenem-based therapy demonstrated the lowest resistance levels. ERCP and age were predictors of bacteriobilia (p<0.001 and p<0.002, respectively), but PCT, CRP and NLR were not CONCLUSION: PLWH should follow the same PAP and EA therapy recommendations as HIV-U. For EA therapy, we recommend a combination of amoxicillin/clavulanate with aminoglycoside-based therapy (amikacin or gentamicin), or piperacillin/tazobactam as monotherapy. Carbapenem-based therapy should be reserved for drug-resistant species. For elective LC, elderly patients or patients who have previously undergone ERCP, we recommend selective use of cefazolin for PAP

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