Analysis of patterns of bacteremia and 30-day mortality in patients with acute cholangitis over a 25-year period

Tan, Ming; Jensen, Thøger Gorm; Nielsen, Stig Lønberg; Muckadell, Ove B Schaffalitzky de; Laursen, Stig Borbjerg

doi:10.1080/00365521.2021.1902558

Cited by 10 publications

(5 citation statements)

References 32 publications

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“…Recent studies showed that risk factors associated with mortality in patients with AC were etiology of malignancy, bacteremia, insufficient drainage, and disease severity. 26 , 27 And use of inappropriate antibiotics was also significant risk factor in patients with bacteremia. 10 However, in this study, there was no statistically significant difference between the two groups with respect to in-hospital mortality and duration of fever although the patients in the antibiotic-resistant group were older, had higher severity of AC, and antibiotic failure rate than those in the non-resistant group.…”

Section: Discussionmentioning

confidence: 99%

Changing Patterns of Causative Pathogens over Time and Efficacy of Empirical Antibiotic Therapies in Acute Cholangitis with Bacteremia

et al. 2022

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Background/Aims To select appropriate empirical antibiotics, updates on the changes in pathogens are essential. We aimed to investigate the changes in pathogens and their antibiotic susceptibility in acute cholangitis (AC) with bacteremia over a period of 15 years. Furthermore, the efficacy of empirical antibiotic therapies and the risk factors predicting antibiotic-resistant pathogens (ARPs) were analyzed. Methods A total of 568 patients with AC and bacteremia who were admitted to Daegu Catholic University Medical Center from January 2006 to December 2020 were included. Their medical records were retrospectively reviewed. In addition, the data were grouped and analyzed at 3-year intervals under the criteria of Tokyo Guideline 2018. Results During the study period, 596 pathogens were isolated from blood cultures of 568 patients. The three most common pathogens were Escherichia coli (50.5%), Klebsiella species (24.5%), and Enterococcus species (8.1%). The proportion of vancomycin-resistant Enterococci (VRE) has increased since the mid-2010 (0.0% to 4.3%, p=0.007). There was emergence of carbapenem-resistant Enterobacteriaceae (CRE) in 2018 to 2020, albeit not statistically significant (1.3%, p=0.096). Risk factors predicting ARP were healthcare-associated infection, history of previous biliary intervention, and the severity of AC. For patients with these aforementioned risk factors, imipenem was the most effective antibiotic and piperacillin-tazobactam was also effective but to a lesser degree (susceptibility rates of 92.1% and 75.0%, respectively). Conclusions The proportion of VRE has increased and CRE has emerged in AC. In addition, healthcare-associated infection, history of previous biliary intervention, and the severity of AC were independent risk factors predicting ARP. For patients with these risk factors, the administration of imipenem or piperacillin-tazobactam should be considered.

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Section: Discussionmentioning

confidence: 99%

Changing Patterns of Causative Pathogens over Time and Efficacy of Empirical Antibiotic Therapies in Acute Cholangitis with Bacteremia

et al. 2022

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“…The predictive ability of Lac for grade I positive bacteremia was better than that of PCT, although not significantly different, suggesting that Lac can be a useful predictive marker for bacteremia in patients with AC, particularly mild cases. Patients with bacteremia have a significantly higher mortality rate, 4,5 but it usually takes several days to verify the presence of bacteremia from blood cultures; using Lac to predict the presence of bacteremia on admission and early biliary drainage, even in mild cases, may help prevent worsening of disease severity. And not only in such mild disease, but also in all grades, the combination of Lac and PCT in grade III significantly increased sensitivity without a significant decrease in specificity.…”

Section: T a B L Ementioning

confidence: 99%

“…3 Septic shock and subsequent death are more frequent in patients with AC who develop bacteremia. 4,5 Therefore, bacteremia detection in the early phase of AC may contribute to improved prognosis.As an AC biomarker, procalcitonin (PCT) has been reported to be useful in predicting the severity of AC in early phases. 6,7 On the other hand, serum lactate (Lac) level has been adopted as a diagnostic marker for septic shock in Sepsis-3 8 and is a prognostic factor for pneumonia.…”

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Diagnostic value of the serum lactate level as a predictor of bacteremia in patients with acute cholangitis

Oura

Nishino

Murakami

et al. 2023

J Hepato Biliary Pancreat

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BackgroundPatients with acute cholangitis (AC) have increased mortality when associated with bacteremia. This study aimed to evaluate the predictive ability of serum lactate (Lac) for positive bacteremia in patients with acute cholangitis.MethodsIn this single‐center, retrospective study, 138 consecutive patients with AC were analyzed. Their blood samples were collected and Lac was measured.ResultsA total of 50 patients showed grade I, 50 showed grade II, and 38 showed grade III severity according to the Tokyo Guidelines 2018. Positive bacteremia was observed in 71 patients, of which 15 showed grade I, 25 showed grade II, and 31 showed grade III severity. Logistic regression analysis showed that Lac was a significant predictor of bacteremia. The area under the curve of Lac and procalcitonin (PCT) for bacteremia were 0.737 and 0.780, respectively. The optimal cutoff values for bacteremia were 17 mg/dL and 2.8 ng/mL, with sensitivity of 69.0% and 68.3%, respectively. Sensitivity of Lac and PCT for bacteremia in grade I was 58.3% and 25.0%, respectively. Three patients died from AC, all of whom were positive for bacteremia and hyperlactatemia.ConclusionLac is useful for predicting bacteremia in patients with AC.

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“…Biliary tract infections are frequent, and a significant cause of morbidity and mortality if not adequately treated ( 1 ). Bacteremia is common in these infections, particularly in the elderly and patients with cancer ( 2 , 3 ).…”

Section: Introductionmentioning

confidence: 99%

Risk Factors and Predictive Score for Bacteremic Biliary Tract Infections Due to Enterococcus faecalis and Enterococcus faecium: a Multicenter Cohort Study from the PROBAC Project

et al. 2022

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Analysis of patterns of bacteremia and 30-day mortality in patients with acute cholangitis over a 25-year period

Cited by 10 publications

References 32 publications

Changing Patterns of Causative Pathogens over Time and Efficacy of Empirical Antibiotic Therapies in Acute Cholangitis with Bacteremia

Changing Patterns of Causative Pathogens over Time and Efficacy of Empirical Antibiotic Therapies in Acute Cholangitis with Bacteremia

Diagnostic value of the serum lactate level as a predictor of bacteremia in patients with acute cholangitis

Risk Factors and Predictive Score for Bacteremic Biliary Tract Infections Due to Enterococcus faecalis and Enterococcus faecium: a Multicenter Cohort Study from the PROBAC Project

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