Clinical characteristics of Gram-negative and Gram-positive bacterial infection in acute cholangitis: a retrospective observational study

Abstract

Background To investigate the difference in the severity of illness, organ dysfunction, and prognosis of acute cholangitis due to different pathogenic bacterial infection types. Methods A retrospective observational study was performed. Patients who met the selection criteria according to blood culture and bile culture results of different pathogenic bacterial were divided into groups. The severity of illness, organ dysfunction, and prognosis of the groups were analyzed and compared comprehensively. Results A total of 424 patients were included, and no bacterial growth developed in 111 patients (26.2%). Among the 313 patients (73.8%) with bacterial growth, 155 patients had only Gram-negative bacteria cultured (49.5%), 48 patients had only Gram-positive bacteria cultured (15.3%), and 110 patients had both Gram-negative and Gram-positive bacteria cultured (35.1%). The proportion of Grade III patients and the APACHE II and SOFA scores of the mixed Gram-negative and positive group were the highest (p < 0.05); the intensive care unit admission day and hospital stay were longer, and the mortality rate were also higher 20/110 (18.2%) than the other two groups. Regression analysis showed that bacterial growth was an independent risk factor for organ dysfunction. The risks of an increased septic shock, neurological dysfunction, hepatic dysfunction, hematological dysfunction, and respiratory dysfunction in the mixed Gram-negative and positive group were higher than the Gram-negative group (P < 0.05). The Cox proportional hazards regression prompt showed that different culture results were independent risk factors for death. The mixed Gram-negative and positive group had increased hazard ratios and 95% CI of 7.30 (95% CI 1.55 to 34.38) compared with the Gram-negative group. There was no difference between the Gram-negative group and the Gram-positive group in the severity of illness, organ dysfunction, intensive care unit admission day, hospital stay, mortality rate, and risk of death (P > 0.05). Conclusions In acute cholangitis, mixed infection with Gram-negative and Gram-positive bacteria was more severe and was associated with a higher risk of death. There were no apparent differences between Gram-negative and Gram-positive bacterial infections.

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

“…ESBL is the most frequently single isolate in bile cultures in patients with cholangitis 15 . In contrast, enterococcus has been shown to be more common in patients with prior stenting and bacteremia, and cholangitis mortality is as high as 7.3 times higher than mortality diagnosed with polymicrobial blood infections 24,25 . Although shown in a surgical setting, 14 additional coded resistant infections were not significant for higher mortality in our post hoc analysis.…”

“…15 In contrast, enterococcus has been shown to be more common in patients with prior stenting and bacteremia, and cholangitis mortality is as high as 7.3 times higher than mortality diagnosed with polymicrobial blood infections. 24,25 Although shown in a surgical setting, 14 additional coded resistant infections were not significant for higher mortality in our post hoc analysis. However, in our sub-analysis, we confirm more VRE and MDRO were associated with biliary stenting (Supplemental Table 3, Supplemental Digital Content 3, http://links.lww.com/JCG/A978), whereas slightly more ESBL were associated with biliary stone removal.…”

Analysis of Pathogenic Bacteria Distribution and Related Factors in Recurrent Acute Cholangitis

“…All 1570 inpatients with acute cholangitis admitted to the First Affiliated Hospital of Chongqing Medical University from July 2013 to January 2022 were considered for being preliminary included, the inclusion and exclusion criteria and case identification refer to our previous study, 13 as shown in Figure 1 . Taking into account some irresistible factors, as detailed in our previous study, 14 503 patients were eventually included.…”

Risk Factors and Prognosis of Carbapenem-Resistant Organism Colonization and Infection in Acute Cholangitis

“…For inclusion and exclusion criteria refer to our previous studies. 18 The inclusion criteria for acute cholangitis and the identification of cases are shown in Figure 1 The following factors prior to hospitalization were also taken into account: infection-related risk factors, whether CRE infection was detected before being hospitalized, pre-admission factors included hospitalization within 3 months (emergency admission, duration of emergency stay, use of carbapenems within 3 months prior to admission, and presence of infection before admission), whether or not a ventilator or artificial airway were used within a month prior to infection, whether the catheter was indwelled, whether the blood flow catheter was indwelled, catching infection previously, whether the patients were admitted to the intensive care unit (ICU), usage of antibacterial drugs, that is, combination of drugs, use of carbapenems, cephalosporins, tetracycline, fluoroquinolones, aminoglycosides, glycopeptides, sulfamides, and other antibacterial drugs, and their hours of use.…”

“…For inclusion and exclusion criteria refer to our previous studies. 18 The inclusion criteria for acute cholangitis and the identification of cases are shown in Figure 1 . In view of the following exclusion factors:) Bile culture and blood culture were not obtained, 2) Received treatment before admission, 3) Organ failure before onset, 4) Transfer to another hospital, and 5) Neither ERCP and surgical drainage were performed, 503 patients were finally included in this research.…”