Prospective insights into acute cholangitis: microbial patterns, resistance, risk factors, and outcomes

This study investigated the microbiological profile, risk factors, antimicrobial resistance, and clinical outcomes in patients with acute cholangitis.

Acute cholangitis is a critical infection resulting from biliary obstruction, with risks of sepsis and high mortality.

This prospective study included 105 patients undergoing biliary drainage for acute cholangitis via endoscopic retrograde cholangiopancreatography or percutaneous transhepatic drainage. Bile and blood cultures were collected. Antimicrobial susceptibility testing was performed. In-hospital outcomes were analysed.

Bacteriologically confirmed cholangitis was identified in nearly half of the patients, with Gram-negative bacteria predominating in both bile and blood cultures. Klebsiella pneumoniae and Escherichia coli were the most common Gram-negative isolates, Staphylococcus aureus was the leading Gram-positive organism, and a small number of Candida species (n=5) were also recovered. Malignant biliary obstruction and higher SOFA scores were associated with positive cultures. Multidrug-resistant organisms (51.8% of isolates), including ESBL-producers and carbapenem-resistant strains, were common. Enterobacteriaceae remained sensitive to carbapenems and tigecycline, whereas Staphylococci were sensitive to linezolid and vancomycin. Culture-positive patients experienced longer hospital stays (P< 0.001) and higher mortality (10%, P= 0.016) compared with negative-culture patients.

-negative bacteria are the primary pathogens in acute cholangitis, and the high burden of multidrug resistance is linked to worse clinical outcomes, particularly in patients with malignant obstruction. Ongoing antibiotic stewardship and local resistance are crucial to optimize empiric therapy and improve patient outcomes.