Clinical characteristics, predictors, and rates of hospitalized acute cholangitis patients in the United States

Babajide, Oyedotun; Ogbon, Ekwevugbe Ochuko; Agbalajobi, Olufunso; Ikeokwu, Anderson; Adelodun, Anuoluwapo; Obomanu, Elvis Tamunotonye

doi:10.20524/aog.2022.0756

Cited by 5 publications

(5 citation statements)

References 18 publications

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“…However, there remains a knowledge gap in the trajectory of antibiotic resistance associated with inpatient ERCPs 19 . Nationwide databases may assist to surveil for emerging trends, including cholangitis and ERCP 20 . This study presents outcomes data from the US health system perspective to examine the longitudinal trends of antibiotic resistance patterns and inpatient ERCP outcomes.…”

Section: Discussionmentioning

confidence: 99%

Increasing Antibiotic-Resistant Infections With Inpatient Endoscopic Retrograde Cholangioscopies (ERCP) Is Associated With Higher Mortality in the United States

Chang

Bui

Zhou

et al. 2023

Journal of Clinical Gastroenterology

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Goals: This study aims to investigate associated mortality with inpatient endoscopic retrograde cholangiopancreatography (ERCP) with and without resistant infections. The co-primary objective compares frequencies of inpatient ERCP with resistant infections to overall hospitalizations with resistant infections. Background: The risks of inpatient antibiotic-resistant organisms are known, but the associated mortality for inpatient ERCP is unknown. We aim to use a national database of hospitalizations and procedures to understand trends and mortality for patients with antibiotic-resistant infections during inpatient ERCP. Study: The largest publicly available all-payer inpatient database in the United States (National Inpatient Sample) was used to identify hospitalizations associated with ERCPs and antibiotic-resistant infections for MRSA, VRE, ESBL, and MDRO. National estimates were generated, frequencies were compared across years, and multivariate regression for mortality was performed. Results: From 2017 to 2020, national weighted estimates of 835,540 inpatient ERCPs were generated, and 11,440 ERCPs had coincident resistant infections. Overall resistant infection, MRSA, VRE, and MDRO identified at the same hospitalization of inpatient ERCPs were associated with higher mortality (OR CI(95%): Overall: 2.2(1.77–2.88), MRSA: 1.90 (1.34–2.69), VRE: 3.53 (2.16–5.76), and MDRO: 2.52 (1.39–4.55)). While overall hospitalizations with resistant infections have been decreasing annually, there has been a yearly increase in admissions requiring ERCPs with simultaneous resistant infections (P=0.001–0.013), as well as infections with VRE, ESBL, and MDRO (P=0.001–0.016). Required Research Practices for Studies Using the NIS scoring was 0, or the most optimal. Conclusions: Inpatient ERCPs have increasing coincident resistant infections and are associated with higher mortality. These rising infections during ERCP highlight the importance of endoscopy suite protocols and endoscopic infection control devices.

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Section: Discussionmentioning

confidence: 99%

Increasing Antibiotic-Resistant Infections With Inpatient Endoscopic Retrograde Cholangioscopies (ERCP) Is Associated With Higher Mortality in the United States

Chang

Bui

Zhou

et al. 2023

Journal of Clinical Gastroenterology

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“…The relationship between sex and acute cholangitis is not very clear. A large-scale study in the United States suggested that more than half of the hospitalized patients with acute cholangitis were over 60 years old, of which men accounted for the majority [2]. Another study also reported that men were more prone to developing acute cholangitis than women among patients with choledocholithiasis [19].…”

Section: ) T-bilmentioning

confidence: 99%

“…It is one of the most common severe diseases in gastroenterology, with an acute onset, rapid progression and high mortality. Without prompt treatment, the mortality rate can reach as high as 50% [1,2]. The common causes of acute cholangitis include choledocholithiasis, pancreatic cancer, porta hepatis tumor or metastasis, primary sclerosing cholangitis, Mirizzi syndrome, benign or malignant stricture of the bile/hepatic ducts and other factors that cause biliary obstruction [3].…”

Section: Introductionmentioning

confidence: 99%

Predictive factors for developing acute cholangitis due to choledocholithiasis

Li,

Dai,

et al. 2024

Preprint

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Background Acute cholangitis, an acute and severe disease in the clinic, is mostly caused by choledocholithiasis. This study aimed to identify the predictive factors for developing acute cholangitis due to choledocholithiasis. Methods A total of 558 patients with choledocholithiasis were enrolled. The patients were divided into a choledocholithiasis group (n = 399) and an acute cholangitis group (n = 159) according to whether they had acute cholangitis. The clinical data were analyzed, and logistic regression was used to predict acute cholangitis. Receiver operating characteristic (ROC) curves were generated to identify predictive factors for acute cholangitis. Results The acute cholangitis group had a greater prevalence of male sex, age ≥ 70 years, smoking history, hypertension, fever (> 38°C) and/or shaking chills, duodenal peripapillary diverticulum, and maximum diameter of choledocholithiasis (≥ 10 mm). Furthermore, the acute cholangitis group had higher WBC, CRP, T-Bil, ALT, AST, ALP, GGT, serum creatinine (Scr), prothrombin time (PT) and D-dimer (D-D) levels and lower albumin levels. Logistic regression analysis revealed that the maximum diameter of choledocholithiasis (≥ 10 mm), T-Bil, CRP, WBC, fever (> 38°C) and/or shaking chills, male sex, AST, and ALP were independent risk factors for developing acute cholangitis, with an area under the ROC curve (AUC) of 0.869 for CRP, 0.858 for T-Bil, 0.835 for WBC, 0.765 for AST and 0.743 for ALP. Conclusions Attention should be given to choledocholithiasis patients who have a maximum diameter of choledocholithiasis (≥ 10 mm), T-Bil > 34.25 µmol/L, CRP > 10.85 mg/L, WBC > 9.95×109/L, fever (> 38℃) and/or shaking chills, male sex, ALP > 162.5 U/L and AST > 57.8 U/L. Interventions may be taken to prevent acute cholangitis.

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“…Treatment for acute cholangitis includes administering antimicrobial drugs, biliary drainage, and addressing the underlying causes [2] . Timely and effective biliary drainage can reduce mortality rates by 2.8% [3,4] . Current clinical approaches for biliary drainage encompass endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangial drainage (PTCD), and surgical drainage.…”

Section: Introductionmentioning

confidence: 99%

Distribution Characteristics, Antimicrobial Resistance, and Variation Trends of Biliary Microbiome in Acute Cholangitis patients : A 7-Year Retrospective Study in a Tertiary Hospital in Northwest China

Hao,

Du,

2024

Preprint

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Background With the increase in bacterial resistance worldwide, the bacterial characteristics of the biliary tract may have changed. Bile specimens for microbiological analysis are obtained primarily during endoscopic retrograde cholangiopancreatography, with a few from percutaneous transhepatic cholangial drainage. However, in some regions of China, patients still undergo laparoscopic T-tube drainage. The lack of data from this subset may lead to an incomplete understanding of the characteristics of the biliary microbiome. Method 1094 hospitalized patients diagnosed acute cholangitis from January 1, 2017 to December 31, 2023, who underwent biliary drainage procedures with bile specimen collection in our hospital were selected.Collect and analyse their general information, results of biliary culture, antimicrobial susceptibility and potential reasons for changes over 7 years. Results Among the 1,094 patients with acute cholangitis, 875 specimens (79.91%) yielded positive bile cultures, facilitating the detection of 1,026 strains belonging to 24 genera and 75 species of pathogens..Gram-negative bacteria were predominant,accounting for 63.65%(653/1,026) of the isolates, followed by gram-positive bacteria at 31.97%(328/1,026) and fungi at 4.39%(45/1,026). The main genera were Escherichia (249, 24.27%), Enterococcus (197, 19.20%), Klebsiella (170, 16.57%). Over the years, there has been a fluctuating upward trend in the diversity of pathogens. From 2017 to 2021, the proportion of gram-negative bacilli gradually decreased while gram-positive cocci increased, although the difference was not statistically significant. However, from 2022 to 2023, the proportion of gram-negative bacilli significantly increased compared to the previous five years.There was an increasing trend in the resistance rates of Escherichia coli and Klebsiella pneumoniae to various antibiotics.They were more sensitive to piperacillin/sulbactam sodium than to cefoperazone/sulbactam sodium. Conclusion The proportion of gram-positive bacteria increased annually in patients without differences in the history of Oddi sphincter incision. Incision of the Oddi sphincter increased the proportion of gram-negative bacteria but did not increase the proportion of major bacterial species and had no significant effect on the distribution of Enterococcus. The detection rates of resistant bacteria increased significantly. The resistance rates of Escherichia coli and Klebsiella pneumoniae to antibiotics showed an overall increasing trend.

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Clinical characteristics, predictors, and rates of hospitalized acute cholangitis patients in the United States

Cited by 5 publications

References 18 publications

Increasing Antibiotic-Resistant Infections With Inpatient Endoscopic Retrograde Cholangioscopies (ERCP) Is Associated With Higher Mortality in the United States

Increasing Antibiotic-Resistant Infections With Inpatient Endoscopic Retrograde Cholangioscopies (ERCP) Is Associated With Higher Mortality in the United States

Predictive factors for developing acute cholangitis due to choledocholithiasis

Distribution Characteristics, Antimicrobial Resistance, and Variation Trends of Biliary Microbiome in Acute Cholangitis patients : A 7-Year Retrospective Study in a Tertiary Hospital in Northwest China

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