Clinical characteristics associated with hospital infections in patients undergoing endoscopic retrograde cholangiopancreatography and laparoscopic common bile duct exploration for common bile duct stones_West China Medical Journal

Authors：

JIN Suxiang ^1,2 , PENG Xiujuan ² , DAI Rui ² , TIAN Caiyun ² , RUAN Yuhua ² ,  ZANG Feng ¹

1. Department of Infection Management, Jiangsu People’s Hospital (the First Affiliated Hospital of Nanjing Medical University), Nanjing, Jiangsu 210029, P. R. China;
2. Department of Infection Management, the Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210031, P. R. China;

Corresponding author：

ZANG Feng, Email: 18652921829@163.com

Keywords：

Endoscopic retrograde cholangiopancreatography; laparoscopic common bile duct exploration; choledocholithiasis; hospital infection; clinical characteristics

DOI：

10.7507/1002-0179.202405246

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Objective To analyze the clinical characteristics associated with hospital infections in patients with common bile duct stones treated by endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic common bile duct exploration (LCBDE), thereby providing a basis for selecting treatment strategies and formulating hospital infection prevention measures for such patients. Methods Patients with common bile duct stones at Jiangsu Provincial People’s Hospital between January 2020 and July 2023 were retrospectively selected and divided into ERCP and LCBDE groups according to their surgical methods. Basic patient data, length of hospital stay, hospitalization costs, perioperative infection-related indicators, and occurance of hospital infections were compared between groups. Results A total of 402 patients were enrolled, with 242 in the ERCP group and 160 in the LCBDE group. Significant differences were noted in smoking, alcohol consumption, history of lung diseases, history of heart diseases, history of cholecystectomy/biliary surgery, presence of cholecystitis, presence of cholecystolithiasis, number of stones, maximum stone diameter, common bile duct diameter, total hospital stay, and total expenses (P<0.05). Twenty-four hours before surgery, except for the neutrophil count, which was slightly higher in the ERCP group than that in the LCBDE group (P=0.043), the infection-related indicators did not differ significantly between the two groups (P>0.05). Twenty-four hours after surgery, the levels of serum white blood cell, neutrophil, and aspartate aminotransferase in the ERCP group were lower than those in the LCBDE group (P<0.05), and the levels of alkaline phosphatase and gamma-glutamyl transferase in the ERCP group were higher than those in the LCBDE group (P<0.05). A total of 179 bile samples were collected and tested, identifying 137 strains of pathogenic bacteria (78 in the ERCP group and 59 in the LCBDE group). In the ERCP group, 42 strains (53.85%) were Gram-negative bacteria, 34 strains (45.59%) were Gram-positive bacteria, and 2 strains (2.56%) were fungi; in the LCBDE group, 33 strains (55.93%) were Gram-negative bacteria and 26 strains (44.07%) were Gram-positive bacteria. No significant difference was observed in the composition of pathogenic bacteria between the two groups (χ²=1.174, P=0.695). Among the 402 patients, 38 cases of hospital infection occurred postoperatively, with an infection rate of 9.45%. The difference in the infection rate between the ERCP group and the LCBDE group were statistically significant (11.98% vs. 5.63%; χ²=4.550, P=0.033). The main sites of infection were bloodstream, lungs, and abdominal-pelvic cavity. Conclusions The predominant pathogens isolated after both ERCP and LCBDE are Gram-negative bacteria. Compared with LCBDE, ERCP has less impact on inflammatory markers, hospital stay, and costs, but has a higher incidence of hospital infections.

Citation： JIN Suxiang, PENG Xiujuan, DAI Rui, TIAN Caiyun, RUAN Yuhua, ZANG Feng. Clinical characteristics associated with hospital infections in patients undergoing endoscopic retrograde cholangiopancreatography and laparoscopic common bile duct exploration for common bile duct stones. West China Medical Journal, 2025, 40(6): 931-936. doi: 10.7507/1002-0179.202405246 Copy

1.	Ding YB, Deng B, Liu XN, et al. Synchronous vs sequential laparoscopic cholecystectomy for cholecystocholedocholithiasis. World J Gastroenterol, 2013, 19(13): 2080-2086.
2.	Liu B, Wu DS, Cao PK, et al. Percutaneous transhepatic extraction and balloon dilation for simultaneous gallbladder stones and common bile duct stones: a novel technique. World J Gastroenterol, 2018, 24(33): 3799-3805.
3.	Manes G, Paspatis G, Aabakken L, et al. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy, 2019, 51(5): 472-491.
4.	汪晓红. 胆囊切除术后胆总管结石的内镜及腹腔镜治疗并胆总管结石复发的相关因素分析. 南京: 南京医科大学, 2017.
5.	ASGE Standards of Practice Committee, Buxbaum JL, Abbas Fehmi SM, et al. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointest Endosc, 2019, 89(6): 1075-1105.
6.	鲁为朋, 孙礼侠, 王晨, 等. ERBD+LCBDE 与 ENBD+ERCP/EST 在胆总管结石合并中重度急性胆管炎中的近期疗效对比. 肝胆胰外科杂志, 2023, 35(1): 40-45.
7.	Ricci C, Pagano N, Taffurelli G, et al. Comparison of efficacy and safety of 4 combinations of laparoscopic and intraoperative techniques for management of gallstone disease with biliary duct calculi: a systematic review and network meta-analysis. JAMA Surg, 2018, 153(7): e181167.
8.	陈兵. 腹腔镜胆总管切开取石一期缝合术 58 例临床分析. 华西医学, 2016, 31(9): 1534-1537.
9.	Rendell VR, Pauli EM. Laparoscopic common bile duct exploration. JAMA Surg, 2023, 158(7): 766-767.
10.	顾卫东, 赵璇, 何振洲. 普通外科围手术期疼痛管理上海专家共识(2020 版). 中国实用外科杂志, 2021, 41(1): 31-37.
11.	中华人民共和国卫生部. 医院感染诊断标准(试行). 中华医学杂志, 2001, 81(5): 61-67.
12.	Satlin MJ, Lewis JS, Weinstein MP, et al. Clinical and laboratory standards institute and european committee on antimicrobial susceptibility testing position statements on polymyxin B and colistin clinical breakpoints. Clin Infect Dis, 2020, 71(9): e523-e529.
13.	中华人民共和国国家卫生健康委员会. 医院感染监测标准 WS/T 312-2023. 中国感染控制杂志, 2023, 22(9): 1129-1142.
14.	Williams E, Beckingham I, El Sayed G, et al. Updated guideline on the management of common bile duct stones (CBDS). Gut, 2017, 66(5): 765-782.
15.	祝长华. 比较(ERCP+LC)与(LC+LCBDE)两种术式治疗胆囊结石合并胆总管结石疗效的 meta 分析. 南昌: 南昌大学, 2023.
16.	贺斌, 张文超, 曾民. 急诊 ERCP 治疗老年患者胆总管结石继发急性重症胆管炎的效果. 中国卫生标准管理, 2023, 14(15): 88-92.
17.	冯其柱, 陈先志, 孙杰, 等. 老年胆总管结石合并急性胆管炎患者 ERCP 术后胆总管结石复发的危险因素分析. 实用医学杂志, 2023, 39(15): 1945-1949.
18.	樊鹏, 陈治富, 王康. 腹腔镜胆总管切开取石术后感染情况及危险因素分析. 临床医学研究与实践, 2023, 8(30): 9-12.
19.	丁孟德, 陈中朝, 王林俊, 等. 胆道结石术后医院感染病原菌及相关影响因素分析. 中华医院感染学杂志, 2018, 28(1): 84-87.
20.	Yin Y, He K, Xia X. Comparison of primary suture and t-tube drainage after laparoscopic common bile duct exploration combined with intraoperative choledochoscopy in the treatment of secondary common bile duct stones: a single-center retrospective analysis. J Laparoendosc Adv Surg Tech A, 2022, 32(6): 612-619.
21.	Lyu Y, Cheng Y, Li T, et al. Laparoscopic common bile duct exploration plus cholecystectomy versus endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for cholecystocholedocholithiasis: a meta-analysis. Surg Endosc, 2019, 33(10): 3275-3286.
22.	胡云龙, 宋正伟, 龙昊, 等. 不同胆总管取石术联合腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石的疗效比较. 成都医学院学报, 2021, 16(1): 46-49.
23.	刘江, 李栋山. 不同胆总管取石术联合腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石的疗效比较. 甘肃科技, 2021, 37(5): 142-145.
24.	马勇新, 张旭升, 柳科军, 等. 恶性胆道梗阻 ERCP 术后早期胆道感染预测模型的建立与评价. 中国普通外科杂志, 2023, 32(8): 1208-1217.
25.	伍婵璐, 姜瑜, 肖燕. 胆管结石合并胆道细菌感染患者胆汁病原菌及其预后影响因素. 中华医院感染学杂志, 2021, 31(2): 238-243.
26.	刘立彬, 杨连营, 杜庆云, 等. 胆总管结石合并急性胆管炎患者 PTCD 胆汁与血培养病原菌分布及耐药性分析. 中华医院感染学杂志, 2019, 29(5): 726-729.
27.	王超智, 侯轩, 王珊, 等. 胆总管结石合并感染患者 ERCP 取石术胆汁中病原菌种类及耐药性. 热带医学杂志, 2020, 20(5): 683-686.
28.	梁秋明, 黄洁玲, 包宏洁, 等. 经内镜逆行胰胆管造影术后胆道感染的危险因素分析及预警模型构建. 中华保健医学杂志, 2022, 24(4): 291-294.
29.	臧凤, 张永祥, 刘波, 等. 重症监护病房老年患者多药耐药菌的感染分布与来源分析. 中华医院感染学杂志, 2020, 30(6): 866-871.
30.	孙亭立, 刘合春, 何春华. ERCP 术后血流感染的危险因素及新型感染性标志物的诊断价值. 中华医院感染学杂志, 2021, 31(17): 2697-2701.

1. Ding YB, Deng B, Liu XN, et al. Synchronous vs sequential laparoscopic cholecystectomy for cholecystocholedocholithiasis. World J Gastroenterol, 2013, 19(13): 2080-2086.
2. Liu B, Wu DS, Cao PK, et al. Percutaneous transhepatic extraction and balloon dilation for simultaneous gallbladder stones and common bile duct stones: a novel technique. World J Gastroenterol, 2018, 24(33): 3799-3805.
3. Manes G, Paspatis G, Aabakken L, et al. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy, 2019, 51(5): 472-491.
4. 汪晓红. 胆囊切除术后胆总管结石的内镜及腹腔镜治疗并胆总管结石复发的相关因素分析. 南京: 南京医科大学, 2017.
5. ASGE Standards of Practice Committee, Buxbaum JL, Abbas Fehmi SM, et al. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointest Endosc, 2019, 89(6): 1075-1105.
6. 鲁为朋, 孙礼侠, 王晨, 等. ERBD+LCBDE 与 ENBD+ERCP/EST 在胆总管结石合并中重度急性胆管炎中的近期疗效对比. 肝胆胰外科杂志, 2023, 35(1): 40-45.
7. Ricci C, Pagano N, Taffurelli G, et al. Comparison of efficacy and safety of 4 combinations of laparoscopic and intraoperative techniques for management of gallstone disease with biliary duct calculi: a systematic review and network meta-analysis. JAMA Surg, 2018, 153(7): e181167.
8. 陈兵. 腹腔镜胆总管切开取石一期缝合术 58 例临床分析. 华西医学, 2016, 31(9): 1534-1537.
9. Rendell VR, Pauli EM. Laparoscopic common bile duct exploration. JAMA Surg, 2023, 158(7): 766-767.
10. 顾卫东, 赵璇, 何振洲. 普通外科围手术期疼痛管理上海专家共识(2020 版). 中国实用外科杂志, 2021, 41(1): 31-37.
11. 中华人民共和国卫生部. 医院感染诊断标准(试行). 中华医学杂志, 2001, 81(5): 61-67.
12. Satlin MJ, Lewis JS, Weinstein MP, et al. Clinical and laboratory standards institute and european committee on antimicrobial susceptibility testing position statements on polymyxin B and colistin clinical breakpoints. Clin Infect Dis, 2020, 71(9): e523-e529.
13. 中华人民共和国国家卫生健康委员会. 医院感染监测标准 WS/T 312-2023. 中国感染控制杂志, 2023, 22(9): 1129-1142.
14. Williams E, Beckingham I, El Sayed G, et al. Updated guideline on the management of common bile duct stones (CBDS). Gut, 2017, 66(5): 765-782.
15. 祝长华. 比较(ERCP+LC)与(LC+LCBDE)两种术式治疗胆囊结石合并胆总管结石疗效的 meta 分析. 南昌: 南昌大学, 2023.
16. 贺斌, 张文超, 曾民. 急诊 ERCP 治疗老年患者胆总管结石继发急性重症胆管炎的效果. 中国卫生标准管理, 2023, 14(15): 88-92.
17. 冯其柱, 陈先志, 孙杰, 等. 老年胆总管结石合并急性胆管炎患者 ERCP 术后胆总管结石复发的危险因素分析. 实用医学杂志, 2023, 39(15): 1945-1949.
18. 樊鹏, 陈治富, 王康. 腹腔镜胆总管切开取石术后感染情况及危险因素分析. 临床医学研究与实践, 2023, 8(30): 9-12.
19. 丁孟德, 陈中朝, 王林俊, 等. 胆道结石术后医院感染病原菌及相关影响因素分析. 中华医院感染学杂志, 2018, 28(1): 84-87.
20. Yin Y, He K, Xia X. Comparison of primary suture and t-tube drainage after laparoscopic common bile duct exploration combined with intraoperative choledochoscopy in the treatment of secondary common bile duct stones: a single-center retrospective analysis. J Laparoendosc Adv Surg Tech A, 2022, 32(6): 612-619.
21. Lyu Y, Cheng Y, Li T, et al. Laparoscopic common bile duct exploration plus cholecystectomy versus endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for cholecystocholedocholithiasis: a meta-analysis. Surg Endosc, 2019, 33(10): 3275-3286.
22. 胡云龙, 宋正伟, 龙昊, 等. 不同胆总管取石术联合腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石的疗效比较. 成都医学院学报, 2021, 16(1): 46-49.
23. 刘江, 李栋山. 不同胆总管取石术联合腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石的疗效比较. 甘肃科技, 2021, 37(5): 142-145.
24. 马勇新, 张旭升, 柳科军, 等. 恶性胆道梗阻 ERCP 术后早期胆道感染预测模型的建立与评价. 中国普通外科杂志, 2023, 32(8): 1208-1217.
25. 伍婵璐, 姜瑜, 肖燕. 胆管结石合并胆道细菌感染患者胆汁病原菌及其预后影响因素. 中华医院感染学杂志, 2021, 31(2): 238-243.
26. 刘立彬, 杨连营, 杜庆云, 等. 胆总管结石合并急性胆管炎患者 PTCD 胆汁与血培养病原菌分布及耐药性分析. 中华医院感染学杂志, 2019, 29(5): 726-729.
27. 王超智, 侯轩, 王珊, 等. 胆总管结石合并感染患者 ERCP 取石术胆汁中病原菌种类及耐药性. 热带医学杂志, 2020, 20(5): 683-686.
28. 梁秋明, 黄洁玲, 包宏洁, 等. 经内镜逆行胰胆管造影术后胆道感染的危险因素分析及预警模型构建. 中华保健医学杂志, 2022, 24(4): 291-294.
29. 臧凤, 张永祥, 刘波, 等. 重症监护病房老年患者多药耐药菌的感染分布与来源分析. 中华医院感染学杂志, 2020, 30(6): 866-871.
30. 孙亭立, 刘合春, 何春华. ERCP 术后血流感染的危险因素及新型感染性标志物的诊断价值. 中华医院感染学杂志, 2021, 31(17): 2697-2701.

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Clinical characteristics associated with hospital infections in patients undergoing endoscopic retrograde cholangiopancreatography and laparoscopic common bile duct exploration for common bile duct stones

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