Risk factors for increased antimicrobial resistance: a retrospective analysis of 309 acute cholangitis episodes

Abstract

Stent therapy was found to be a risk factor for increased antimicrobial resistance in patients with acute cholangitis, particularly those who had undergone numerous interventional procedures prior to the onset of the cholangitis.

Risk Factors for Multi-Drug Resistant Pathogens and Failure of Empiric First-Line Therapy in Acute Cholangitis

“…These results are consistent with those of a recently published study by Schneider et al . [23], in which biliary stenting was identified as the major risk factor for developing AC with 3GC-resistant bacteria. Because biliary stents are generally changed regularly, biliary stenting can be considered a surrogate marker for previous hospitalization, which is known to affect both antibiotic exposure and antibiotic resistance profiles [24].…”

The impact of delayed biliary decompression and anti‐microbial therapy in 260 patients with cholangitis‐associated septic shock

“…29 However, that study was not designed to look at time delay to initiation of appropriate anti-microbials. Schneider et al have previously reported that risk factors for anti-microbial resistance include stenting and previous biliary instrumentation, 30 and drugs such as proton pump inhibitors may impact the microbiological spectrum in cholangitis. 31 In this analysis of acute cholangitis patients, when a defined pathogen is isolated, initial administration of inappropriate anti-microbial therapy and delay of administration of appropriate anti-microbial therapy beyond 12 hours after the onset of septic shock/ hypotension was associated with a hospital mortality rate of 80%.…”

Pyogenic Liver Abscess of Biliary Origin: The Existing Problems and Their Strategies

“…15,16,73,74 The widespread uses of third-generation cephalosporins and aztreonam are believed to be the major cause of the emergence of ESBLs, 75,76 which are β-lactamases commonly found in the Enterobacteriaceae family and resistant to all β-lactam antibiotics except cephamycins and carbapenems. 75 Biliary stenting in the preoperative stage is significantly associated with an increased risk of MDR bacteria, 18,63,65,77,78 and it is the only independent risk factor for acute cholangitis caused by MDR bacteria. 18,77,78 Chronic bacterobilia is significantly associated with bacteremia related to recurrent acute cholangitis, especially MDR bacterial bacteremia.…”

“…75 Biliary stenting in the preoperative stage is significantly associated with an increased risk of MDR bacteria, 18,63,65,77,78 and it is the only independent risk factor for acute cholangitis caused by MDR bacteria. 18,77,78 Chronic bacterobilia is significantly associated with bacteremia related to recurrent acute cholangitis, especially MDR bacterial bacteremia. [15][16][17][18][19]77 From the previously mentioned facts, biliary pathologies such as IBDS and EBDS, biliodigestive anastomosis, and bile duct stenting can lead to a higher overall rate of bacterial colonization as well as MDR bacteria colonization in bile cultures, which can result in recurrent episodes of acute cholangitis, bacteremia, and PLA.…”

“…Ascending infections from intestine into bile duct may be the main cause of polymicrobial infections in patients with biliary infection due to IBDS and EBDS. 47 Many studies suggest that preoperative biliary drainage can induce a shift of the biliary microbiome toward a more aggressive and resistant spectrum, [17][18][19]57,63,78,115 and acute cholangitis due to bile obstruction is more often caused by MDR organisms. [17][18][19]113 Furthermore, polymicrobial infections and MDR infections in patients with PLA of biliary origin are more likely to occur in patients with abnormal bilioenteric communications such as papillotomy and bile duct stent placement and hepaticojejunostomy, of which acute episodes of ascending cholangitis due to the functional loss of Oddi's sphincter are treated by more uses of broad-spectrum antibiotics especially third-/ fourth-generation cephalosporins, 4,5,18,114,115 which are believed to be the major cause of the mutations in these enzymes (TEM1, TEM2, and SHV1) that lead to the ESBLs emergence.…”