Changes in Causative Pathogens of Acute Cholangitis and Their Antimicrobial Susceptibility over a Period of 6 Years

Kwon, Jeong Seok; Han, Jimin; Kim, Tae Won; Oh, Ji Hye; Kwon, Hyun Hee; Jung, Jin Tae; Kwon, Joong Goo; Kim, Eun Young; Kim, Ho Gak

doi:10.4166/kjg.2014.63.5.299

Cited by 21 publications

(13 citation statements)

References 34 publications

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“…In this study, 693 strains of pathogenic bacteria were isolated and 64.6% were Gram-negative bacteria. There were 210 strains of Escherichia coli (30.3%), 76 strains of Klebsiella pneumoniae (11.0%) and 32 strains of Enterobacter cloacae (4.6%), 35.4% were gram positive bacteria, including 87 strains of Enterococcus faecium (12.6%) and 71 strains of Enterococcus faecalis (10.2%), Similar to the pathogens reported in previous studies, they all belong to digestive tract bacteria [11,12,13]. It can prompt clinicians to use drugs empirically, In the treatment of patients with biliary tract infection, we can improve the function of digestive tract, maintain the patency of gastrointestinal tract and reduce the pressure in gastrointestinal tract., it can also reduce biliary tract infection theoretically [14,15].…”

Section: Discussionsupporting

confidence: 76%

Analysis of Common Pathogenic Bacteria and Drug Resistance of Biliary Tract Infection in Nanjing Area

Yang¹,

Song²

2021

AJCMR

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Background: Analyze the distribution and drug resistance of pathogenic bacteria that cause biliary tract infections in Nanjing, and provide evidence for the rational use of antibacterial drugs in clinical practice. Methods: Clinical strains isolated from bile specimens of patients suspected of biliary infection in the First Affiliated Hospital of Nanjing Medical University in 2019 were collected, The drug susceptibility criteria are based on the standards published by the National Standardization Committee of the US Clinical Laboratories. WHONET 5.6 software was used to analyze the distribution of pathogens and drug resistance. Results: A total of 693 strains of pathogenic bacteria were isolated, including 448 Gram-negative bacteria(64.6%), 245 Gram-positive bacteria (35.4%). The top three pathogens were 210 strains of Escherichia coli(30.3%), 87 strains of enterococcus faecium (12.6%), 76 strains of klebsiella pneumoniae (11.0%), The resistance rates of Escherichia coli to ampicillin, cefuroxime, cefazolin, ceftriaxone, piperacillin and ampicillin / sulbactam were 80.1%, 69.4%, 67.3%, 64.1%, 63.6% and 62.8%, The resistance rates of Klebsiella pneumoniae to ampicillin / sulbactam, cefuroxime and cefazolin were 65.8%, 64.5% and 61.1%, The resistance rates of Enterobacter cloacae to ceftriaxone, ceftazidime and aztreonam were 56.2%, 53.1% and 53.1%, The resistance rates of Enterococcus faecium to moxifloxacin, clindamycin, erythromycin, penicillin G, ampicillin, ciprofloxacin and levofloxacin were 100%, 90%, 76%, 72.1%, 64.4%, 64% and 62%. Conclusions: Pathogens of biliary tract infections are mainly Enterobacteriaceae such as Escherichia coli and Klebsiella pneumoniae, followed by Enterococcus faecium and Enterococcus faecalis. There were many drug-resistant bacteria, so we should pay attention to bile specimen culture and drug sensitivity test.

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Section: Discussionsupporting

confidence: 76%

Analysis of Common Pathogenic Bacteria and Drug Resistance of Biliary Tract Infection in Nanjing Area

Yang¹,

Song²

2021

AJCMR

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“…In several studies performed throughout the world, the percentage of MDR bacteria isolated from the bile of patients with AC exceeded 20 to 30% [18], and intrinsically 3GC-resistant enterococci are isolated in 36–74% of AC episodes [8,28,22], particularly those involving patients with underlying biliary disease, e.g., sclerosing cholangitis [8], or a liver transplant [28]. In our study, empiric treatment with 3GC did not cover the isolated pathogens in more than 50% of patients and required the escalation of therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Because microbes and resistance patterns show both regional and temporal variations [18,11,19], the aims of this retrospective study were to (i) characterize the contemporary microbial patterns of BD cultures performed in two German tertiary care centers using a pathogen-based approach and (ii) identify risk factors for AC by pathogens resistant to empiric antibiotic therapies and the associated outcomes using a patient-based approach.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Multi-Drug Resistant Pathogens and Failure of Empiric First-Line Therapy in Acute Cholangitis

et al. 2017

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BackgroundAcute cholangitis (AC) requires the immediate initiation of antibiotic therapy in addition to treatment for biliary obstruction. Against a background of an increasing prevalence of multi-drug resistant (MDR) bacteria, the risk factors for the failure of empiric therapy must be defined.MethodsUsing a pathogen-based approach, 1764 isolates from positive bile duct cultures were retrospectively analyzed to characterize the respective pathogen spectra in two German tertiary centers. Using a patient-based approach, the clinical and laboratory data for 83 patients with AC were assessed to identify risk factors for AC with pathogens resistant to the applied empiric therapy.ResultsBile cultures were predominantly polymicrobial, and empiric antibiotic therapies did not cover the full biliary pathogen spectrum in 78% of cases. MDR bacteria were isolated from the bile of 24/83 (29%) patients. The univariate risk factors for biliary MDR bacteria were male sex, nosocomial AC, prior antibiotic exposure and prior biliary stenting, of which biliary stenting was the only independent risk factor according to multivariate analysis (OR = 3.8; 95% CI 1.3–11.0, P = 0.013). Although there were no significant differences in survival or hospital stay in AC patients with and without detected biliary MDR pathogens, the former more often had a concomitant bloodstream infection (58% vs. 24%; P = 0.019), including those involving MDR pathogens or fungi (21% vs. 2%; P = 0.007).ConclusionPatients with biliary stents who develop AC should receive empiric therapy covering enterococci and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. These patients are at an increased risk for bloodstream infections by MDR pathogens or fungi.

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“…A prospective cohort study in patients with acute cholecystitis involving 116 institutions worldwide showed that among 96 isolated E. coli , 16 (16.7%) were producing ESBL . However, the proportion of ESBL producing E. coli varies widely region to region: 31.2% in two German university hospitals , 70.0% in Korean university medical center and 66% in Indian medical college hospital . There are few reports about the prevalence of carbapenem resistant bacteria specifically among patients with acute cholangitis and cholecystitis.…”

Section: Introductionmentioning

confidence: 99%

Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis

Gomi

Solomkin

Schlossberg

et al. 2018

J Hepato Biliary Pancreat

298

249

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Antimicrobial therapy is a mainstay of the management for patients with acute cholangitis and/or cholecystitis. The Tokyo Guidelines 2018 (TG18) provides recommendations for the appropriate use of antimicrobials for community-acquired and healthcare-associated infections. The listed agents are for empirical therapy provided before the infecting isolates are identified. Antimicrobial agents are listed by classdefinitions and TG18 severity grade I, II, and III subcategorized by clinical settings. In the era of emerging and increasing antimicrobial resistance, monitoring and updating local antibiograms is underscored. Prudent antimicrobial usage and early de-escalation or termination of antimicrobial therapy are now important parts of decision-making. What is new in TG18 is that the duration of antimicrobial therapy for both acute cholangitis and cholecystitis is systematically reviewed. Prophylactic antimicrobial usage for elective endoscopic retrograde cholangiopancreatography is no longer recommended and the section was deleted in TG18. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.

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Changes in Causative Pathogens of Acute Cholangitis and Their Antimicrobial Susceptibility over a Period of 6 Years

Abstract: The most common causative pathogen of acute cholangitis was ESBL-producing E. coli. Prevalence of C. freundii increased over the time period. Imipenem should be reserved as an alternative for resistant pathogens.

Cited by 21 publications

References 34 publications

Analysis of Common Pathogenic Bacteria and Drug Resistance of Biliary Tract Infection in Nanjing Area

Analysis of Common Pathogenic Bacteria and Drug Resistance of Biliary Tract Infection in Nanjing Area

Risk Factors for Multi-Drug Resistant Pathogens and Failure of Empiric First-Line Therapy in Acute Cholangitis

Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis

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