BACKGROUND: Knowledge of bacterial spectrum for acute cholangitis is essential for adequate empiric antibiotic treatment. Main focus of the study was to analyse the spectrum of pathogens in acute cholangitis with and without biliary endoprosthesis. METHODS: Retrospective cohort study of 1024 patients with acute cholangitis treated at a German tertiary center. RESULTS: 447 cholangitis episodes with positive bile and/or blood cultures obtained from 388 patients were studied. In total, 1088 pathogen were isolated. The predominant strains were Enterococcus species (25%), followed by Escherichia coli (18%) and Klebsiella species (14%). Bacteraemia was mainly caused by E. coli (91/282; 32%) and Enterococcus species (550/282; 18%). The incidences of Enterococcus species [121(74%) vs. 89(60%); p = 0.011] and non-fermenters [41(25%) vs. 16(11%); p = 0.001] were significantly higher in cholangitis episodes with biliary endoprosthesis compared to cholangitis episodes without biliary endoprosthesis. In particular, more Pseudomonas aeruginosa [27(16%) vs. 12(8%); p = 0.027] and Enterococcus faecium [59(36%) vs. 34(23%); p = 0.013] were isolated from patients with a biliary endoprosthesis. CONCLUSIONS: Unlike cholangitis without stent, the presence of biliary endoprosthesis in patients with cholangitis can serve as a surrogate indicator of nosocomial pathogens and therefore should be considered, when selecting empiric antimicrobial therapy.
BACKGROUND: Knowledge of bacterial spectrum for acute cholangitis is essential for adequate empiric antibiotic treatment. Main focus of the study was to analyse the spectrum of pathogens in acute cholangitis with and without biliary endoprosthesis. METHODS: Retrospective cohort study of 1024 patients with acute cholangitis treated at a German tertiary center. RESULTS: 447 cholangitis episodes with positive bile and/or blood cultures obtained from 388 patients were studied. In total, 1088 pathogen were isolated. The predominant strains were Enterococcus species (25%), followed by Escherichia coli (18%) and Klebsiella species (14%). Bacteraemia was mainly caused by E. coli (91/282; 32%) and Enterococcus species (550/282; 18%). The incidences of Enterococcus species [121(74%) vs. 89(60%); p = 0.011] and non-fermenters [41(25%) vs. 16(11%); p = 0.001] were significantly higher in cholangitis episodes with biliary endoprosthesis compared to cholangitis episodes without biliary endoprosthesis. In particular, more Pseudomonas aeruginosa [27(16%) vs. 12(8%); p = 0.027] and Enterococcus faecium [59(36%) vs. 34(23%); p = 0.013] were isolated from patients with a biliary endoprosthesis. CONCLUSIONS: Unlike cholangitis without stent, the presence of biliary endoprosthesis in patients with cholangitis can serve as a surrogate indicator of nosocomial pathogens and therefore should be considered, when selecting empiric antimicrobial therapy.
Authors: Edgar Ortiz-Brizuela; José Sifuentes-Osornio; Daniel Manzur-Sandoval; Santiago Mier Y Terán-Ellis; Sergio Ponce-de-León; Pedro Torres-González; Miguel Ángel Mercado Journal: J Gastrointest Surg Date: 2017-07-25 Impact factor: 3.452
Authors: Jochen Schneider; Alexander Hapfelmeier; Julia Fremd; Philipp Schenk; Andreas Obermeier; Rainer Burgkart; Stefanie Forkl; Susanne Feihl; Nina Wantia; Bruno Neu; Monther Bajbouj; Stefan von Delius; Roland M Schmid; Hana Algül; Andreas Weber Journal: PLoS One Date: 2014-10-14 Impact factor: 3.240
Authors: Christoph Lübbert; Karolin Wendt; Jürgen Feisthammel; Annette Moter; Norman Lippmann; Thilo Busch; Joachim Mössner; Albrecht Hoffmeister; Arne C Rodloff Journal: PLoS One Date: 2016-05-12 Impact factor: 3.240
Authors: Philipp A Reuken; Dorian Torres; Michael Baier; Bettina Löffler; Christoph Lübbert; Norman Lippmann; Andreas Stallmach; Tony Bruns Journal: PLoS One Date: 2017-01-11 Impact factor: 3.240
Authors: Marcus M Mücke; Johanna Kessel; Victoria T Mücke; Katharina Schwarzkopf; Michael Hogardt; Christoph Stephan; Stefan Zeuzem; Volkhard A J Kempf; Christian M Lange Journal: BMC Infect Dis Date: 2017-06-26 Impact factor: 3.090