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Risk Factors for Acute Cholangitis Caused by Extended-Spectrum Beta-Lactamase and AmpC-Producing Organisms
Takuro Nishiwaki1,2, Shigenobu Yoshimura1, Naoto Hosokawa3
1Department of Gastroenterology, Kameda Medical Center, Kamogawa, Japan.
Introduction:
Prompt antibiotic administration is essential in the management of acute cholangitis (AC). In selecting initial antibiotics, it is important to consider both the severity of the condition and the antimicrobial activity spectrum, particularly against major resistant bacteria. Extended-spectrum β-lactamases and AmpC productions are key factors in pathogen resistance; however, knowledge of patient characteristics in cholangitis management remains limited. We aimed to analyze risk factors for extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) and for chromosomally mediated AmpC-producing Enterobacteriaceae (CAE).
Methods:
This study retrospectively analyzed patients with AC who underwent endoscopic retrograde cholangiopancreatography (ERCP) at a tertiary center in Japan between April 1, 2018, and April 30, 2024. This analysis focused on evaluating the first episode of AC during hospitalization.
Results:
A total of 721 patients with cholangitis underwent ERCP. ESBL-E was detected as the causative pathogen in 22 cases, whereas CAE was identified in 113 cases. Patients with CAE experienced a significantly higher recurrence rate within 60 days (15.9% vs. 4.3%, p < 0.001) and required more frequent escalation to broad-spectrum antibiotics (19.5% vs. 8.7%, p = 0.001). No significant differences in clinical outcomes were observed between patients with and without ESBL-E. Multivariate analysis identified independent risk factors for AC caused by ESBL-E: previous antibiotic use within 90 days, dialysis, and residence in nursing homes. For CAE, independent risk factors included antibiotic use within 90 days and a history of endoscopic sphincterotomy (EST).
Conclusion:
In AC, recent antibiotic use, dialysis, and institutionalization are associated with ESBL-E, whereas recent antibiotic use and a history of EST are linked to CAE.
Insights
Risk factors for resistant bacteria in acute cholangitis (AC) include prior antibiotic use, dialysis, and nursing home residence for extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E). Chromosomally mediated AmpC-producing Enterobacteriaceae (CAE) risk factors include prior antibiotic use and endoscopic sphincterotomy history.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Microbiology
Background:
- Prompt antibiotic administration is critical for acute cholangitis (AC) management.
- Selecting antibiotics requires considering severity and resistance patterns, especially for extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) and chromosomally mediated AmpC-producing Enterobacteriaceae (CAE).
- Patient characteristics influencing resistance in AC are not well understood.
Purpose of the Study:
- To identify risk factors associated with ESBL-E and CAE in patients with AC.
Main Methods:
- Retrospective analysis of 721 AC patients undergoing ERCP at a tertiary center in Japan (April 2018 - April 2024).
- Focused on the first AC episode during hospitalization.
- Multivariate analysis was used to determine independent risk factors.
Main Results:
- CAE (113 cases) showed higher recurrence rates (15.9% vs. 4.3%) and more frequent broad-spectrum antibiotic escalation (19.5% vs. 8.7%) compared to ESBL-E (22 cases).
- No significant clinical outcome differences were observed between ESBL-E and non-ESBL-E groups.
- Independent risk factors for ESBL-E included prior antibiotic use, dialysis, and nursing home residence.
- Independent risk factors for CAE included prior antibiotic use and history of endoscopic sphincterotomy (EST).
Conclusions:
- Recent antibiotic use, dialysis, and institutionalization are linked to ESBL-E in AC.
- Recent antibiotic use and a history of EST are associated with CAE in AC.
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