Clinicomicrobiological analysis of patients with cholangitis

Abstract

Acute cholangitis is inflammation of biliary ductal system from infection with an associated biliary obstruction. This retrospective study was done to determine the factors responsible for cholangitis and the microbiological profile of the bile in patients with cholangitis. In the study involving 348 patients, 36.4% had associated malignancy. A total of 54% of the bile samples were positive for aerobic culture. Nearly 66-73% of the Escherichia coli and Klebsiella isolates were Extended spectrum beta lactamases (ESBL) producers. Two isolates of Candida spps were also obtained. Polymicrobial infection was seen in 31.5% of the culture positive cases. Ideal antibiotics in case of cholangitis would be those which are excreted in the bile such as third-generation cephalosporins, ureidopenicillins, carbapenems and fluoroquinolones to combat resistance and polymicrobial aetiology. Anti-fungal drugs may also be necessary if the patient is not responding to biliary decompression and antibacterial agents to prevent fungaemia.

Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis

“…A prospective cohort study in patients with acute cholecystitis involving 116 institutions worldwide showed that among 96 isolated E. coli , 16 (16.7%) were producing ESBL . However, the proportion of ESBL producing E. coli varies widely region to region: 31.2% in two German university hospitals , 70.0% in Korean university medical center and 66% in Indian medical college hospital . There are few reports about the prevalence of carbapenem resistant bacteria specifically among patients with acute cholangitis and cholecystitis.…”

ACR Appropriateness Criteria® Radiologic Management of Biliary Obstruction

“…Selection of antibiotics should include those with a broad range of antimicrobial activity with good penetration into the bile ducts. Examples include thirdgeneration cephalosporins, ureidopenicillins, carbapenems, and fluoroquinolones [31].…”

Cholangitis: Diagnosis, Treatment and Prognosis

“… 84 For the best practice, administrated antibiotics for cholangitis should be those with broad range antimicrobial activities and which are capable of passing into the bile duct, such as third-generation cephalosporins, ureidopenicillins, carbapenems and fluoroquinolones. 86 The most effective antibiotics for cholangitis patients have been noted as imipenem-cilastatin, meropenem, amikacin, cefepime, ceftriaxone, gentamicin, piperacillin-tazobactam and levofloxacin. 87 , 88 …”

“…The rates of polymicrobial-positive cultures in AC vary from 30–78%, 86 , 89 , 90 and the response rate to antibiotics in AC is satisfactory in the majority of patients. 40 The achievement of effective antibiotic therapy for AC decreased the death rate of this condition dramatically during the 1970s through 1980.…”

“… 95 A high rate of positive cultures has been reported for PSC patients. 86 , 89 The idea that antibiotic therapy may be useful in slowing down the progression of PSC originates from studies that described a role for bacterial species residing in the human gastrointestinal tract in the pathogenesis of PSC. 96 However, antibiotic therapy for 12 weeks with rifaximin resulted in no significant effects on the clinical course of PSC.…”