The microbiology of acute cholangitis and associatedin-hospital mortality
The microbiology of acute cholangitis and associatedin-hospital mortality
Aim: Acute cholangitis is an infection that may become life-threatening. In this study, we investigated the most prevalent organisms identified in cultures, antibiotic resistance patterns and associated in-hospital mortality. Materials and Methods: Patients diagnosed as having acute cholangitis were included in the study retrospectively. The study patients were classified in two groups by culture results as culture-negative or culture-positive patients. The aim of the study was to identify offending organisms, antibiotic resistance and in-hospital mortality based on culture results.Results: Overall, 108 patients with acute cholangitis were evaluated in two groups. Sixty six patients (61.2%) had positive cultures and 43 (40%) of these patients had polymicrobial culture results. There was a predominance of gram-negative bacteria (63%) and particularly, Klebsiella spp. and E.coli were the most commonly isolated organisms. The patients who died had 90.9% positive cultures, whereas those who survived had 53.6% culture positivity (p=0.02)Conclusions: Biliary stent implantaiton was found to be the most common etiological factor for acute cholangitis. In terms of culture results, K. pneumoniae and E. coli were the most commonly isolated causative agents. ESBL resistance was found with a rate of 48.5% and carbapenem resistance was found with a rate of 22% for gram negative bacilli. Culture positivity was a risk factor in terms of in-hospital death.
___
- 1. Kiriyama S, Takada T, Strasberg SM, et al. TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2013;20:24-34.
- 2. Mayumi T, Takada T, Kawarada Y, et al. Results of the Tokyo Consensus Meeting Tokyo Guidelines. J Hepatobiliary Pancreat Sci 2007;14:114.
- 3. Takada T, Strasberg SM, Solomkin JS, et al. TG13: Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 2013;20:1-7.
- 4. Tadahiro T. Tokyo Guidelines 2018: updated Tokyo Guidelines for the management of acute cholangitis/ acute cholecystitis J Hepatobiliary Pancreat Sci 2018;25:1-2
- 5. Hanau LH , Steigbigel NH . Acute (ascending) cholangitis . Infect Dis Clin North Am 2000;14:521-46. 6. Gigot JF , Leese T , Dereme T, et al. Acute cholangitis. Multivariate analysis of risk factors. Ann Surg 1989;209:435-8.
- 7. Melzer M , Toner R , Lacey S, et al. Biliary tract infection and bacteraemia: presentation, structural abnormalities, causative organisms and clinical outcomes. Postgrad Med J 2007;83:773-6.
- 8. Van den Hazel SJ, Speelman P, Tytgat GNJ, et al Role of antibiotics in the treatment and prevention of acute and recurrent cholangitis. Clin Infect Dis 1994;19:279- 86.
- 9. Gomi H, Solomkin JS, Takada T , et al. TG13 antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 2013;20:60-70.
- 10. Itoi T, Tsuyuguchi T, Takada T, et al. TG13 indications and techniques for biliary drainage in acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 2013;20:71-80.
- 11. Sartelli M, Weber DG, Ruppe E, et al. Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA). World J Emerg Surg 2016;11:33.
- 12. Harumi G, Tadahiro T, Tsann-Long H, et al. Updated comprehensive epidemiology, microbiology, and outcomes among patients with acute cholangitis J Hepatobiliary Pancreat Sci 2017;24:310-8
- 13. Reuken PA, Torres D, Baier M, et al Risk Factors for Multi-Drug Resistant Pathogens and Failure of Empiric First-Line Therapy in Acute Cholangitis PLoS One 2017;12:e0172373.
- 14. Tohda G, Ohtani M, Dochin M. Efficacy and safety of emergency endoscopic retrograde cholangiopancreatography for acute cholangitis in the elderly. World J Gastroenterol 2016;22:8382-8.
- 15. Sung YK, Lee JK, Lee KH, et al, The Clinical Epidemiology and Outcomes of Bacteremic Biliary Tract Infections Caused by Antimicrobial-Resistant Pathogens. Am J Gastroenterol 2012;107:473-83.
- 16. Kim YK, Pai H, Lee HJ, et al. Bloodstream infections by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in children: epidemiology and clinical outcome . Antimicrob Agents Chemother 2002;46:1481-91.
- 17. Kang CI, Kim SH, Park WB, et al. Bloodstream infections caused by Enterobacter species: predictors of 30- day mortality rate and impact of broad-spectrum cephalosporin resistance on outcome Clin Infect Dis 2004;39:812-8.
- 18. Kang CI, Kim SH, Kim DM, et al. Risk factors for and clinical outcomes of bloodstream infections caused by extended-spectrum beta-lactamase-producing Klebsiella pneumoniae . Infect Control Hosp Epidemiol 2004;25:860-7.
- 19. Kim BN, Woo J, Kim MN, e t al. Clinical implications of extendedspectrum beta-lactamase-producing Klebsiella pneumoniae bacteraemia. J Hosp Infect 2002;52:99-106.