Korean J Gastroenterol.  2014 May;63(5):299-307. 10.4166/kjg.2014.63.5.299.

Changes in Causative Pathogens of Acute Cholangitis and Their Antimicrobial Susceptibility over a Period of 6 Years

Affiliations
  • 1Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea. mhan@cu.ac.kr

Abstract

BACKGROUND/AIMS
We evaluated changes of causative pathogen in acute cholangitis and their antimicrobial susceptibility over six years and differences between community-acquired and hospital-acquired acute cholangitis at our institution.
METHODS
Medical records of 1,596 patients with acute cholangitis and biliary drainage between August 2006 and August 2012 were reviewed retrospectively. Cases were divided according to time: period 1 (August 2006-December 2008, n=645, 40.4%), period 2 (January 2009-August 2012, n=951, 59.6%). Cases were divided according to community-acquired cholangitis (n=1,397, 87.5%) and hospital-acquired cholangitis (n=199, 12.5%). Causative pathogens and antimicrobial susceptibility were investigated in each group.
RESULTS
Causative pathogen was isolated from bile culture in 1,520 out of 1,596 cases (95.2%). The three most frequently isolated Gram-negative bacteria were extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (n=485, 30.4%), E. coli (n=237, 13.2%), and Citrobacter freundii (n=110, 6.9%). Between periods 1 and 2, prevalence of ESBL-producing E. coli and Klebsiella pneumoniae did not show significant change (36.7% vs. 32.1%, p=0.073; 6.6% vs. 6.2%, p=0.732). C. freundii showed a significant increase from period 1 to period 2 (1.7% vs. 13.2%, p=0.000). In both time periods, imipenem was the antimicrobial agent showing the highest rate of susceptibility (93.3% vs. 93.9%, p=0.783). Higher prevalence of ESBL-producing E. coli and C. freundii was observed in the hospital-acquired cholangitis group (52.1% vs. 31.2%, p=0.000; 15.9% vs. 7.3%, p=0.001).
CONCLUSIONS
The most common causative pathogen of acute cholangitis was ESBL-producing E. coli. Prevalence of C. freundii increased over the time period. Imipenem should be reserved as an alternative for resistant pathogens.

Keyword

Cholangitis; Microbial sensitivity tests; Antimicrobial drug resistance

MeSH Terms

Acute Disease
Aged
Aged, 80 and over
Anti-Bacterial Agents/*pharmacology
Cholangitis/diagnosis/*microbiology
*Citrobacter freundii/drug effects/isolation & purification
Community-Acquired Infections/microbiology
Cross Infection/microbiology
Drug Resistance, Bacterial
*Escherichia coli/drug effects/isolation & purification
Female
Humans
Imipenem/pharmacology
*Klebsiella pneumoniae/drug effects/isolation & purification
Male
Microbial Sensitivity Tests
Middle Aged
Retrospective Studies
Time Factors
beta-Lactamases/metabolism
Anti-Bacterial Agents
Imipenem
beta-Lactamases
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