{"id":2112,"date":"2018-10-20T18:40:32","date_gmt":"2018-10-20T16:40:32","guid":{"rendered":"https:\/\/angh.net\/abstracts\/quelle-est-lecologie-bacterienne-des-angiocholites-resultats-dune-etude-monocentrique-de-prelevements-endoscopiques-de-bile\/"},"modified":"2018-11-29T11:38:50","modified_gmt":"2018-11-29T10:38:50","slug":"quelle-est-lecologie-bacterienne-des-angiocholites-resultats-dune-etude-monocentrique-de-prelevements-endoscopiques-de-bile","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/quelle-est-lecologie-bacterienne-des-angiocholites-resultats-dune-etude-monocentrique-de-prelevements-endoscopiques-de-bile\/","title":{"rendered":"Quelle est l’\u00e9cologie bact\u00e9rienne des angiocholites ? r\u00e9sultats d’une \u00e9tude monocentrique de pr\u00e9l\u00e8vements endoscopiques de bile"},"content":{"rendered":"

2018<\/strong><\/p>\n

F. Heluwaert , A. Turcry , L. Renaud , L. Tracanelli , E. Abousalihac , I. Lienhart, A. Montchaud, J. Pofelski , M. Baconnier , E Maillard, E. Thimonier , P. Capony , S. Bland . Centre Hospitalier Annecy Genevois.<\/em><\/p>\n

Endoscopie <\/strong>– \u00a02018-05-18 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

L\u2019angiocholite est une urgence th\u00e9rapeutique fr\u00e9quente, dont le traitement repose avant tout sur un drainage biliaire endoscopique et une antibioth\u00e9rapie syst\u00e9mique, le plus souvent par une association ceftriaxone + m\u00e9tronidazole.
\nL\u2019objectif de ce travail \u00e9tait de connaitre les esp\u00e8ces bact\u00e9riennes retrouv\u00e9es dans la bile et les h\u00e9mocultures dans ce contexte.<\/p>\n

Dans notre centre, 136 pr\u00e9l\u00e8vements de bile, obtenus par aspiration de la bile d\u00e8s l\u2019introduction du sphinct\u00e9rotome, associ\u00e9s \u00e0 l\u2019envoi des proth\u00e8ses extraites en bact\u00e9riologie, ont \u00e9t\u00e9 r\u00e9alis\u00e9s lors de cath\u00e9t\u00e9rismes r\u00e9trogrades successifs pour angiocholites de 2014 a 2016.<\/p>\n

Les pr\u00e9l\u00e8vements de bile \u00e9taient r\u00e9partis en 3 groupes :<\/p>\n

Groupe TEMOIN (n=36) : patients en dehors de tout contexte infectieux (n\u00e9oplasie pancr\u00e9atique ou lithiase chol\u00e9docienne).
\nGroupe ANGIOCHOLITE NATIVE (n=56) : survenant chez des patients en angiocholite non pr\u00e9alablement sphinct\u00e9rotomis\u00e9s.
\nGroupe ANGIOCHOLITE SECONDAIRE (n=35) : survenant chez des patients en angiocholite porteurs de proth\u00e8ses biliaires ou d\u00e9j\u00e0 sphinct\u00e9rotomis\u00e9s<\/p>\n

Dans ce contexte d\u2019angiocholite, les antibioth\u00e9rapies syst\u00e9miques prescrites \u00e9taient les suivantes :
\nceftriaxone + m\u00e9tronidazole (n=55), amoxicilline + acide clavulanique (n=8), pip\u00e9racilline + tazobactam (n=6), ofloxacine + m\u00e9tronidazole (n=3) ou aucun ATB (n=15).<\/p>\n

La CPRE \u00e9tait r\u00e9alis\u00e9e en moyenne 4 jours (1-12) apr\u00e8s l\u2019introduction des ATB .<\/p>\n

GROUPE TEMOIN :
\n– Seuls 22% (8\/36) des pr\u00e9l\u00e8vements \u00e9taient st\u00e9riles
\n– Les esp\u00e8ces les plus fr\u00e9quemment identifi\u00e9es (sup a 10%) \u00e9taient : Rothia mucilaginosa, Strepto parasanguis, Strepto salivarus, Actinomyces odontolycus, correspondant \u00e0 des germes de la flore buccale (flore permettant d\u2019exclure ces principales bact\u00e9ries dans les groupes angiocholites).<\/p>\n

GROUPE ANGIOCHOLITE NATIVE :
\n– La bile n\u2019\u00e9tait retrouv\u00e9e st\u00e9rile que dans 7,1% (4\/56),
\n– Le nombre moyen de bact\u00e9ries identifi\u00e9es dans la bile \u00e9tait 1,33 (0-5),
\n– Avec en % de pr\u00e9sence dans la bile : Enterococcus faecalis (48,2%), E coli (28,5%), Enterococcus Faecium (19,6%), Enterococcus avium (10,7%), Proteus vulgaris (10,7%), pseudomonas aeruginosa (7,1%).<\/p>\n

GROUPE ANGIOCHOLITE SECONDAIRE :
\n– Aucune bile n\u2019\u00e9tait st\u00e9rile.
\n– Le nombre moyen de bact\u00e9ries identifi\u00e9es \u00e9tait de 2,62 (0-5),
\n– Enterococcus faecalis (57,1%), E. coli (51,4%), Enterococcus avium (25,7%), Proteus vulgaris (25,7%), Enterobacter cloacae (22,8%), Klebsiella pneumoniae (17,1%), Citrobacter freundii (14,2%), Clostridum perfringens (11,4%), Proteus mirabilis (11,4%), E faecium (8,5%) , E Gallinarum (8,5%), Hafnia alvei (8,5%), Klebsiella oxytoca (8,5%), Prevotella oralis (8,5%)<\/p>\n

Seuls 5,5% des t\u00e9moins \u00e9tait porteur de candida, mais plus grande fr\u00e9quence dans les angiocholites natives (17,8%) et surtout dans les angiocholites secondaires (25%). La fr\u00e9quence de bact\u00e9ries ana\u00e9robies \u00e9tait \u00e9galement plus importante dans les angiocholites secondaires.<\/p>\n

HEMOCULTURES :
\n– 24\/49 h\u00e9mocultures se sont r\u00e9v\u00e9l\u00e9es positives.
\n– Les principales bact\u00e9ries identifies en h\u00e9mocultures \u00e9taient E coli (n=17), Enterococus (n=7)(, Klebsielle (n=2), enterobacter kobei (1), Raoultella (1), proteus (1).
\n– Les germes identifi\u00e9s dans les h\u00e9mocultures sont un reflet partiel et incomplet des germes pr\u00e9sents dans la bile.<\/p>\n

Cette \u00e9tude descriptive montre :<\/p>\n

Que l\u2019on ne peut obtenir une st\u00e9rilisation de la bile avec un seul traitement antibiotique<\/p>\n

Que le drainage est imp\u00e9ratif pour traiter une angiocholite, et qu\u2019il doit \u00eatre r\u00e9alis\u00e9 le plus pr\u00e9cocement possible, puisque l\u2019antibioth\u00e9rapie est constamment insuffisante.<\/p>\n

Que l\u2019antibioth\u00e9rapie habituellement prescrite (C3G + m\u00e9tronidazole) est habituellement efficace sur les germes pr\u00e9sents dans les h\u00e9mocultures (majorit\u00e9 d\u2019E coli), mais habituellement inefficace sur les ent\u00e9rocoques (famille majeure identifi\u00e9e dans la bile) en raison de la r\u00e9sistance naturelle des ent\u00e9rocoques aux c\u00e9phalosporines.<\/p>\n

– Les angiocholites secondaires ne pr\u00e9sentent pas la m\u00eame r\u00e9partition que les angiocholites natives d\u2019E coli, de proteus et de klebsielle, d\u2019enterobacter et de citrobacter, ce qui est un argument suppl\u00e9mentaire pour obtenir un drainage rapide, voir l\u2019utilisation de proth\u00e8se m\u00e9tallique couverte pour permettre leur ablation et possiblement une antibioth\u00e9rapie plus large en raison d\u2019une charge bact\u00e9rienne plus importante et vari\u00e9e.<\/p>\n[download id=\u00a0\u00bb2239″]\n","protected":false},"excerpt":{"rendered":"

2018 F. Heluwaert , A. Turcry , L. Renaud , L. Tracanelli , E. Abousalihac , I. Lienhart, A. Montchaud, J. Pofelski , M. Baconnier , E Maillard, E. Thimonier , P. Capony , S. Bland . Centre Hospitalier Annecy Genevois. Endoscopie – \u00a02018-05-18 –\u00a0CO – ________________________________ L\u2019angiocholite est une urgence th\u00e9rapeutique fr\u00e9quente, dont le […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[6],"tags":[29],"class_list":["post-2112","post","type-post","status-publish","format-standard","hentry","category-endoscopie","tag-29"],"yoast_head":"\nQuelle est l'\u00e9cologie bact\u00e9rienne des angiocholites ? r\u00e9sultats d'une \u00e9tude monocentrique de pr\u00e9l\u00e8vements endoscopiques de bile - Abstracts des congr\u00e8s de l'ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/quelle-est-lecologie-bacterienne-des-angiocholites-resultats-dune-etude-monocentrique-de-prelevements-endoscopiques-de-bile\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Quelle est l'\u00e9cologie bact\u00e9rienne des angiocholites ? 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