Effect of Antibiotic Resistance of Pathogens on Initial Antibiotic Therapy for Patients With Cholangitis.

Sakue Masuda,Chikamasa Ichita,Akiko Sasaki,Haruki Uojima,Kazuya Koizumi,Karen Kimura,Takashi Nishino,Junichi Tasaki

doi:10.7759/cureus.18449

Abstract

ObjectivesConsidering that pathogens resistant to initial antibiotic therapies for cholangitis can affect mortality rates, appropriate initial empiric antibiotic therapy is important. However, evidence regarding the influence of pathogens resistant to initial antibiotics in patients with cholangitis who have undergone early endoscopic retrograde cholangiopancreatography (ERCP) is limited, and the conditions in several cases can improve with early ERCP even when pathogens resistant to initial antibiotics are detected on time. Therefore, this study aimed to assess the influence of pathogens resistant to initial antibiotics on the course of cholangitis in patients undergoing early ERCP.Materials and methodsPatients (n=266) with positive blood or bile culture results treated with early ERCP were divided into those with cultures that were resistant to the initial antibiotics (antibiotic-resistant group; n=66; 24.8%) and those with cultures that were sensitive to the initial antibiotics (antibiotic-sensitive group; n=200; 75.2%). The duration of hospitalization, in-hospital mortality rates due to cholangitis, rates of increased disease severity, and complications during hospitalization were studied.ResultsEnterococcus, Enterobacter, Citrobacter, and Pseudomonas species showed high resistance to several antibiotics. No significant between-group differences were found in the duration of hospitalization, in-hospital mortality rates due to cholangitis, and rates of increased disease severity. However, the rate of post-ERCP cholecystitis was significantly higher in the antibiotic-resistant group than in the antibiotic-sensitive group (p=0.0245).ConclusionsEven if the initial antibiotics were ineffective, the rate of fatal outcomes did not increase among patients with cholangitis who had undergone early ERCP. However, when initial antibiotics were ineffective, the frequency of post-ERCP cholecystitis increased even after early bile duct decompression.

Highlights

Cholangitis is the second most common cause of community-acquired bacteremia and bacteremia in older patients [1,2]
Patients (n=266) with positive blood or bile culture results treated with early endoscopic retrograde cholangiopancreatography (ERCP) were divided into those with cultures that were resistant to the initial antibiotics and those with cultures that were sensitive to the initial antibiotics
The rate of postERCP cholecystitis was significantly higher in the antibiotic-resistant group than in the antibiotic-sensitive group (p=0.0245)

Summary

Introduction

Cholangitis is the second most common cause of community-acquired bacteremia and bacteremia in older patients [1,2]. Cholangitis-related mortality rates are relatively high at 5%-10% [3,4], among older patients [5,6]. Some studies have suggested that infection caused by pathogens resistant to the initial antibiotic therapy in patients with cholangitis is a predictor of mortality [7,8]. Appropriate initial empiric antibiotics should be administered to ensure favorable clinical outcomes. The recommended initial empiric antibiotics are typically administered to patients with cholangitis depending on the risk category, and treatment is tailored according to the susceptibility results of the culture. Evidence for appropriate initial empiric antibiotics is insufficient [9]

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