Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar 12;20(1):65.
doi: 10.1186/s12876-020-01201-6.

Use of microbiological and patient data for choice of empirical antibiotic therapy in acute cholangitis

Tassilo Kruis  1   2 , Sarah Güse-Jaschuck  3 , Britta Siegmund  3 , Thomas Adam  4 , Hans-Jörg Epple  3
Affiliations

Use of microbiological and patient data for choice of empirical antibiotic therapy in acute cholangitis

Tassilo Kruis et al. BMC Gastroenterol. .

Abstract

Background: Ineffective antibiotic therapy increases mortality of acute cholangitis. The choice of antibiotics should reflect local resistance patterns and avoid the overuse of broad-spectrum agents. In this study, we analysed how results of bile and blood cultures and patient data can be used for selection of empirical antibiotic therapy in acute cholangits.

Methods: Pathogen frequencies and susceptibility rates were determined in 423 positive bile duct cultures and 197 corresponding blood cultures obtained from 348 consecutive patients with acute cholangitis. Patient data were retrieved from the medical records. Associations of patient and microbiological data were assessed using the Chi-2 test and multivariate binary logistic regression.

Results: In bile cultures, enterobacterales and enterococci were isolated with equal frequencies of approximately 30% whereas in blood cultures, enterobacterales predominated (56% compared to 21% enterococci). Antibiotic resistance rates of enterobacterales were > 20% for fluorochinolones, cephalosporines and acylureidopenicillins but not for carbapenems (< 2%). The efficacy of empirical therapy was poor with a coverage of bacterial bile and blood culture isolates in 51 and 69%, respectively. By multivariate analysis, predictors for pathogen species, antibiotic susceptibility and expected antibiotic coverage were identified.

Conclusions: In unselected patients treated for acute cholangitis in a large tertiary refferential center, use of carbapenems seems necessary to achieve a high antibiotic coverage. However, by analysis of patient and microbiological data, subgroups for highly effective carbapenem-sparing therapy can be defined. For patients with community-acquired cholangitis without biliary prosthesis who do not need intensive care, piperacillin/tazobactam represents a regimen with an expected excellent antibiotic coverage.

Keywords: Acute cholangitis; Antimicrobial resistance; Biliary tract infection; Carbapenem-sparing therapy; Empirical antibiotic therapy; Gastrointestinal tract microbiology.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study design
Fig. 2
Fig. 2
a Linear trends between the number of biliary tract (BT) interventions and the frequency of infections by enterobacterales (diamonds), enterococci (squares), and P.aeruginosa (crosses). b Linear trends between the number of BT interventions and the frequency of infections by third generation cephalosporine-resistant enterobacterales (3GCRE, diamonds), multi-resistant gram-negative rods (MRGN, squares), and vancomycin-resistant enterococci (VRE, triangles), respectively
See this image and copyright information in PMC

References

    1. Lee JG. Diagnosis and management of acute cholangitis. Nat Rev Gastroenterol Hepatol. 2009;6(9):533–541. doi: 10.1038/nrgastro.2009.126. - DOI - PubMed
    1. Gomi H, Takada T, Hwang TL, Akazawa K, Mori R, Endo I, et al. Updated comprehensive epidemiology, microbiology, and outcomes among patients with acute cholangitis. J Hepatobiliary Pancreat Sci. 2017;24(6):310–318. doi: 10.1002/jhbp.452. - DOI - PubMed
    1. Ortega M, Marco F, Soriano A, Almela M, Martínez JA, López J, et al. Epidemiology and prognostic determinants of bacteraemic biliary tract infection. J Antimicrob Chemother. 2012;67(6):1508–1513. doi: 10.1093/jac/dks062. - DOI - PubMed
    1. Gomi H, Solomkin Joseph S, Schlossberg D, et al. Tokyo guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2018;25(1):3–16. doi: 10.1002/jhbp.518. - DOI - PubMed
    1. Morrissey I, Hackel M, Badal R, Bouchillon S, Hawser S, Biedenbach D. A review of ten years of the Study for Monitoring Antimicrobial Resistance Trends (SMART) from 2002 to 2011. Pharmaceuticals. 2013;6:1335–1346. doi: 10.3390/ph6111335. - DOI - PMC - PubMed

Substances