胆道感染（包括急性和ERCP术后胆管炎）中的微生物学与抗菌药物耐药性：一项系统综述和荟萃分析。
完整摘要 · 中文译文
背景：胆道感染中胆汁培养出的微生物及其耐药性在不同环境间差异很大，缺乏用于指导经验性治疗的合并估计。 目的：估计胆汁培养阳性率、微生物分布及耐药性。 设计：对PubMed及参考文献列表进行系统评价和随机效应荟萃分析。 环境：报告涵盖亚洲、欧洲、非洲和北美的九个国家。 方法：我们从2015年至2025年发表的胆道感染/胆管炎的观察性研究中提取胆管胆汁培养数据；排除非感染性、仅胆囊、仅微生物组及无法提取数据的报告。采用DerSimonian-Laird模型、亚组分析和JBI评价。 主要结局指标：培养阳性率；次要指标为微生物比例和耐药性。 样本量：5147例患者（97%为回顾性；3%为前瞻性）；微生物：35 267条观察数据。 结果：阳性率为77.3%（95% CI，67.8-84.6）；革兰阴性菌69.8%（65.6-73.7），大肠埃希菌27.4%（23.5-31.7），肺炎克雷伯菌14.1%（12.3-16.2）。 异质性：I2=86.0%-97.7%；所有P<.001。 偏倚风险：14篇报告为低风险，2篇为中等风险；排除后对估计值影响极小。 结论：胆汁培养阳性率高，以革兰阴性菌为主，尤其是大肠埃希菌和肺炎克雷伯菌，但估计值异质性很高，耐药性无法合并；因此，依据当地抗菌药物谱指导的培养导向治疗优于普遍的经验性方案。 局限性：仅检索PubMed/开放获取、回顾性设计、不 定义不一致，单一主导数据集。 注册：在 OSF 上回顾性注册（89wqs；DOI：10.17605/OSF.IO/89WQS）。
完整摘要 · 英文原文
BACKGROUND: Organisms cultured from bile in biliary tract infection, and their resistance, vary widely between settings, and pooled estimates to guide empirical therapy are lacking. OBJECTIVE: Estimate bile-culture yield, organism distribution, and resistance. DESIGN: Systematic review and random-effects meta-analysis of PubMed and reference lists. SETTING: Reports spanned nine countries across Asia, Europe, Africa, and North America. METHODS: We extracted ductal-bile culture data from observational studies published from 2015 to 2025 of biliary infection/cholangitis; noninfectious, gall bladder-only, microbiome-only, and nonextractable reports were excluded. DerSimonian-Laird models, subgroup analysis, and JBI appraisal were used. MAIN OUTCOME MEASURE: Culture yield; secondary organism proportions and resistance. SAMPLE SIZE: 5147 patients (97% retrospective; 3% prospective); organisms: 35 267 observations. RESULTS: Yield was 77.3% (95% CI, 67.8-84.6); Gram-negative organisms 69.8% (65.6-73.7), E. coli, 27.4% (23.5-31.7), K. pneumoniae, 14.1% (12.3-16.2). HETEROGENEITY: I2=86.0%-97.7%; all P<.001. RISK OF BIAS: Fourteen reports were low risk, two moderate; exclusions minimally changed estimates. CONCLUSION: Bile-culture yield was high and Gram-negative organisms, particularly E. coli and K. pneumoniae, predominated, but estimates were highly heterogeneous and resistance could not be pooled; culture-directed therapy guided by local antibiograms is therefore preferable to a universal empirical regimen. LIMITATIONS: PubMed-only/open-access search, retrospective designs, inconsistent definitions, one dominant dataset. REGISTRATION: Retrospectively registered on OSF (89wqs; DOI: 10.17605/OSF.IO/89WQS).