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Risk factors and predictors for mixed Gram-negative and Gram-positive bacterial infection in acute cholangitis

Shijing Tian1, Chang Liu1, Yuanyuan Xu1

  • 1Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, PR China.

Diagnostic Microbiology and Infectious Disease
|July 27, 2026
PubMed
Abstract

Insights

Mixed bacterial infections in acute cholangitis increase mortality risk. Key predictors include cardiovascular disease, renal insufficiency, and biliary interventions. Understanding these factors improves patient outcomes.

Area of Science:

  • Infectious Diseases
  • Gastroenterology
  • Critical Care Medicine

Background:

  • Mixed bacterial infections in acute cholangitis are associated with increased severity and mortality.
  • Identifying risk factors for mixed infections is crucial for improving patient management.

Purpose of the Study:

  • To identify independent risk factors and predictors for mixed Gram-negative and Gram-positive bacterial infections in patients with acute cholangitis.

Main Methods:

  • Retrospective review of 503 patients with acute cholangitis.
  • Analysis of blood and bile culture results, clinical data, and laboratory findings.
  • Multivariate analysis to determine independent risk factors.

Main Results:

  • Mixed bacterial infections occurred in 26.6% of patients and were an independent risk factor for in-hospital death (OR 5.23).
  • Associated risk factors included cardiovascular disease, chronic renal insufficiency, biliary stent placement, surgical drainage history, and biliary anastomosis.
  • ROC curves for APACHE II and SOFA scores showed moderate predictive value for mixed infections (0.721 and 0.718, respectively).

Conclusions:

  • Cardiovascular disease, chronic renal insufficiency, prior surgical interventions (incision/drainage, anastomosis), and biliary stent placement are significant risk factors for mixed bacterial infections in acute cholangitis.
  • These findings aid in risk stratification and targeted interventions for acute cholangitis patients.
Keywords:
Acute cholangitisPathogenRisk factors

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