1
|
Onishi K, Morioka H, Imaizumi T, Tsuchimoto D, Nishio M, Komiyama T. Risk factors for cefmetazole-non-susceptible bacteremia in acute cholangitis. J Infect Chemother 2024; 30:423-428. [PMID: 37981024 DOI: 10.1016/j.jiac.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Cefmetazole (CMZ), an antibiotic with limited international distribution, is recommended by the Tokyo Guidelines 2018 (TG18) for non-severe cases of acute cholangitis (AC). However, the risk factors for CMZ-non-susceptible (CMZ-NS) bacteremia in AC remain unclear. Here, we aimed to investigate the risk factors for CMZ-NS bacteremia and evaluate mortality in patients with AC. METHODS This single-center, retrospective, observational study included all patients diagnosed with definite bacteremic AC, based on TG18, from April 2019 to March 2023. Risk factors for CMZ-NS bacteremia were analyzed by univariate, and age- and sex-adjusted, logistic regression analyses. Mortality was compared by cause of obstruction, CMZ-susceptible/CMZ-NS bacteremia, and initial treatment. RESULTS In total, 165 patients were enrolled. CMZ-NS bacteremia was diagnosed in 46 (27.9 %) patients. Histories of diabetes mellitus, hepato-biliary-pancreatic cancer, malignant biliary obstruction, and endoscopic sphincterotomy were identified as significant factors associated with the risk of CMZ-NS bacteremia. Thirteen patients died within 30 days of hospital admission. The mortality of patients with AC and malignant biliary obstruction was statistically higher than that of patients with bile duct stones. No patients with AC and bile duct stones died in the group with CMZ-NS bacteremia and inappropriate initial antibiotics. CONCLUSIONS In AC, a history of diabetes mellitus, hepato-biliary-pancreatic cancer, malignant biliary obstruction, and endoscopic sphincterotomy are associated with an increased risk of CMZ-NS bacteremia. Therefore, the choice of empiric therapy for AC should be based on the etiology and patient background, rather than on the severity.
Collapse
Affiliation(s)
- Katsuhiro Onishi
- Department of Pharmacy, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan; Infection Control Team, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan
| | - Hiroshi Morioka
- Infection Control Team, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan; Department of Infectious Diseases, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Takahiro Imaizumi
- Department of Advanced Medicine, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Daisuke Tsuchimoto
- Department of Pharmacy, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan; Infection Control Team, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan
| | - Mitsuru Nishio
- Infection Control Team, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan; Department of Clinical Laboratory, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan
| | - Takuma Komiyama
- Department of Gastroenterology, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan
| |
Collapse
|
2
|
Masuda S, Imamura Y, Ichita C, Jinushi R, Kubota J, Kimura K, Makazu M, Sato R, Uojima H, Koizumi K. Efficacy of Short-Course Antibiotic Therapy for Acute Cholangitis With Positive Blood Cultures: A Retrospective Study. Cureus 2024; 16:e58883. [PMID: 38800172 PMCID: PMC11117024 DOI: 10.7759/cureus.58883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Short-term treatment of acute cholangitis is sufficient for cure compared with the standard treatment duration. Whether this short-course antimicrobial therapy is effective in patients with acute cholangitis with positive blood cultures has not been fully investigated. This study assessed whether patients with acute cholangitis could achieve successful outcomes with a three-day or shorter antimicrobial treatment period, even with a positive blood culture. METHODS This single-center retrospective study involved patients with acute cholangitis, defined according to the Tokyo Guidelines 2018 for any cause, who underwent successful biliary drainage and completed a seven-day or shorter antimicrobial treatment. Patients were categorized into six groups based on the duration of antibiotic use (short or standard) after endoscopic retrograde cholangiopancreatography and blood culture findings (positive, negative, or no collection). The primary outcome was the clinical cure rate, defined as no initial presenting symptoms by day 14 after biliary drainage and no recurrence or death by day 30. Secondary outcomes included a three-month recurrence rate and length of hospital stay. RESULTS In total, 389 cases were selected, and 27 patients (6.9%) undergoing short-course therapy tested positive for blood culture. The clinical cure rate (n=25, 92.6%) in this group was comparable to that in the other groups. For the three-month recurrence rate (n=1, 3.7%) and median hospital stay (six days), this group's outcomes were either better or similar to those of the other groups. CONCLUSIONS For cases of successful drainage in acute cholangitis, even with positive blood cultures, short-term antibiotic therapy may be appropriate.
Collapse
Affiliation(s)
- Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, JPN
| | - Yoshinori Imamura
- Division of Medical Oncology/Hematology, University of Fukui Hospital, Fukui, JPN
| | - Chikamasa Ichita
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, JPN
| | - Ryuhei Jinushi
- Department of Gastroenterology, Saitama Medical University international Medical Center, Hidaka, JPN
| | - Jun Kubota
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, JPN
| | - Karen Kimura
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, JPN
| | - Makomo Makazu
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, JPN
| | - Ryo Sato
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, JPN
| | - Haruki Uojima
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, JPN
| | - Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, JPN
| |
Collapse
|
3
|
Lee JM, Kang JS, Choi YJ, Byun Y, Jin SH, Yoon KC, Lee HW, Jang JY, Lim CS. Suggested use of empirical antibiotics in acute cholecystitis based on bile microbiology and antibiotic susceptibility. HPB (Oxford) 2023; 25:568-576. [PMID: 36804057 DOI: 10.1016/j.hpb.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 12/13/2022] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Bacterial infection is common in acute cholecystitis (AC). To identify appropriate empirical antibiotics, we investigated AC-associated microorganisms and their susceptibilities to antibiotics. We also compared preoperative clinical findings of patients grouped according to specific microorganisms. METHODS Patients who underwent laparoscopic cholecystectomy for AC between 2018 and 2019 were enrolled. Bile cultures and antibiotic susceptibility tests were performed, and clinical findings of patients were noted. RESULTS A total of 282 patients were enrolled (147 culture-positive and 135 culture-negative). The most frequent microorganisms were Escherichia (n = 53, 32.7%), Enterococcus (n = 37, 22.8%), Klebsiella (n = 28, 17.3%), and Enterobacter (n = 18, 11.1%). For Gram-negative microorganisms, second-generation cephalosporin (cefotetan: 96.2%) was more effective than third-generation cephalosporin (cefotaxime: 69.8%). Vancomycin and teicoplanin (83.8%) were the most effective antibiotics for Enterococcus. Patients with Enterococcus had higher rates of CBD stones (51.4%, p = 0.001) and biliary drainage (81.1%, p = 0.002), as well as higher levels of liver enzymes, than patients with other microorganisms. Patients with ESBL-producing bacteria had higher rates of CBD stones (36.0% vs. 6.8%, p = 0.001) and biliary drainage (64.0% vs. 32.4%, p = 0.005) than those without. DISCUSSION Preoperative clinical findings of AC are related to microorganisms in bile samples. Periodic antibiotic susceptibility tests should be conducted to select appropriate empirical antibiotics.
Collapse
Affiliation(s)
- Jung M Lee
- Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, South Korea
| | - Jae S Kang
- Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, South Korea
| | - Yoo J Choi
- Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, South Korea
| | - Yoonhyeong Byun
- Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, South Korea
| | - Shi H Jin
- Division of Infectious Disease, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, South Korea
| | - Kyung C Yoon
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, South Korea
| | - Hae W Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, South Korea
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, South Korea
| | - Chang-Sup Lim
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, South Korea.
| |
Collapse
|
4
|
Mussa M, Martínez Pérez-Crespo PM, Lopez-Cortes LE, Retamar-Gentil P, Sousa-Dominguez A, Goikoetxea-Aguirre AJ, Reguera-Iglesias JM, León Jiménez E, Fernández-Natal I, Armiñanzas-Castillo C, Boix-Palop L, Cuquet-Pedragosa J, Morán Rodríguez MÁ, Fernandez-Suarez J, del Arco-Jiménez A, Jóver-Saenz A, Bahamonde-Carrasco A, Galan-Sanchez F, Sánchez-Calvo JM, Smithson-Amat A, Vinuesa-García D, Sánchez-Porto A, López-Hernández I, Rodríguez-Baño J. Risk Factors and Predictive Score for Bacteremic Biliary Tract Infections Due to Enterococcus faecalis and Enterococcus faecium: a Multicenter Cohort Study from the PROBAC Project. Microbiol Spectr 2022; 10:e0005122. [PMID: 35771010 PMCID: PMC9431494 DOI: 10.1128/spectrum.00051-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/10/2022] [Indexed: 12/07/2022] Open
Abstract
Biliary-tract bloodstream infections (BT-BSI) caused by Enterococcus faecalis and E. faecium are associated with inappropriate empirical treatment and worse outcomes compared to other etiologies. The objective of this study was to investigate the risk factors for enterococcal BT-BSI. Patients with BT-BSI from the PROBAC cohort, including consecutive patients with BSI in 26 Spanish hospitals between October 2016 and March 2017, were selected; episodes caused by E. faecalis or E. faecium and other causes were compared. Independent predictors for enterococci were identified by logistic regression, and a predictive score was developed. Eight hundred fifty episodes of BT-BSI were included; 73 (8.5%) were due to target Enterococcus spp. (48 [66%] were E. faecium and 25 [34%] E. faecalis). By multivariate analysis, the variables independently associated with Enterococcus spp. were (OR; 95% confidence interval): cholangiocarcinoma (4.48;1.32 to 15.25), hospital acquisition (3.58;2.11 to 6.07), use of carbapenems in the previous month (3.35;1.45 to 7.78), biliary prosthesis (2.19;1.24 to 3.90), and moderate or severe chronic kidney disease (1.55;1.07 to 2.26). The AUC of the model was 0.74 [95% CI0.67 to 0.80]. A score was developed, with 7, 6, 5, 4, and 2 points for these variables, respectively, with a negative predictive value of 95% for a score ≤ 6. A model, including cholangiocarcinoma, biliary prosthesis, hospital acquisition, previous carbapenems, and chronic kidney disease showed moderate prediction ability for enterococcal BT-BSI. Although the score will need to be validated, this information may be useful for deciding empirical therapy in biliary tract infections when bacteremia is suspected. IMPORTANCE Biliary tract infections are frequent, and a significant cause of morbidity and mortality. Bacteremia is common in these infections, particularly in the elderly and patients with cancer. Inappropriate empirical treatment has been associated with increased risk of mortality in bacteremic cholangitis, and the probability of receiving inactive empirical treatment is higher in episodes caused by enterococci. This is because many of the antimicrobial agents recommended in guidelines for biliary tract infections lack activity against these organisms. To the best of our knowledge, this is the first study analyzing the predictive factors for enterococcal BT-BSI and deriving a predictive score.
Collapse
Affiliation(s)
- Marco Mussa
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Diseases Unit, Milan, Italy
- UGC Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Departamento de Medicina, Universidad de Sevilla/IBiS/CSIC, Sevilla, Spain
| | - Pedro María Martínez Pérez-Crespo
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Sevilla, Spain
- Hospital Universitario de Valme, Sevilla, Spain
| | - Luis Eduardo Lopez-Cortes
- UGC Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Sevilla, Spain
| | - Pilar Retamar-Gentil
- UGC Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Departamento de Medicina, Universidad de Sevilla/IBiS/CSIC, Sevilla, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Sevilla, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Inmaculada López-Hernández
- UGC Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Sevilla, Spain
| | - Jesús Rodríguez-Baño
- UGC Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Departamento de Medicina, Universidad de Sevilla/IBiS/CSIC, Sevilla, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Sevilla, Spain
| | - the PROBAC REIPI/GEIH-SEIMC/SAEI group
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Diseases Unit, Milan, Italy
- UGC Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Departamento de Medicina, Universidad de Sevilla/IBiS/CSIC, Sevilla, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Sevilla, Spain
- Hospital Universitario de Vigo, Vigo, Spain
- Hospital de Cruces, Bilbao, Spain
- Hospital Regional de Málaga, Málaga, Spain
- Hospital Universitario de Valme, Sevilla, Spain
- Complejo Asistencial Universitario de León, León, Spain
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
- Hospital Universitari Mútua de Terrasa, Barcelona, Spain
- Hospital General Granollers, Barcelona, Spain
- Hospital Universitario de Burgos, Burgos, Spain
- Hospital Universitario Central de Asturias, Oviedo, Spain
- Hospital Costa del Sol, Marbella, Spain
- Hospital Universitario Arnau de Vilanova, Lleida, Spain
- Hospital de El Bierzo, Ponferrada, Spain
- Hospital Universitario Puerta del Mar, Cadiz, Spain
- Hospital de Jerez de la Frontera, Jerez de la Frontera, Spain
- Hospital de l’Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain
- Hospital Universitario San Cecilio, Granada, Spain
- Hospital del SAS de La Línea de la Concepción, Cádiz, Spain
| |
Collapse
|
5
|
Analysis of the Bacterial Spectrum and Key Clinical Factors of Biliary Tract Infection in Patients with Malignant Obstructive Jaundice after PTCD. DISEASE MARKERS 2022; 2022:1026254. [PMID: 35942130 PMCID: PMC9356864 DOI: 10.1155/2022/1026254] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/01/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022]
Abstract
Objective To analyze the bacterial spectrum and key clinical factors associated with biliary tract infections following percutaneous transhepatic cholangial drainage (PTCD) for malignant obstructive jaundice (MOJ). Methods This retrospective study comprised patients with MOJ who were treated with PTCD from 1st June 2016 to 31st December 2020. Patient clinical data, development of postprocedure biliary tract infections, spectrum of pathogenic bacteria, and drug sensitivity were analyzed, focusing on antibiotic drug resistance and identifying key associated risk factors for postoperative biliary tract infections. Results Of the 528 study patients, 80 were diagnosed with postoperative biliary tract infections, 58 of whom had pathogenic bacteria detected in their bile samples. A total of 90 strains of pathogenic bacteria and 3 strains of fungi were detected; the top 4 were Escherichia coli, Klebsiella pneumoniae, Enterococcus faecium, and Pseudomonas aeruginosa. By univariate analysis, a positive bile culture following PTCD was closely correlated with both the location and degree of preoperative obstruction and the preoperative bilirubin level. Moreover, the results of logistic regression analysis concluded that complete obstruction and a high preoperative total bilirubin level prior to PTCD were independent risk factors for a positive bile culture following PTCD. Conclusion Biliary tract infections following PTCD for MOJ were principally due to Escherichia coli, and bacteria in the bile were statistically more likely to be detected in patients with complete obstruction and high preoperative bilirubin levels.
Collapse
|
6
|
Hung YP, Lee CC, Ko WC. Effects of Inappropriate Administration of Empirical Antibiotics on Mortality in Adults With Bacteraemia: Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:869822. [PMID: 35712120 PMCID: PMC9197423 DOI: 10.3389/fmed.2022.869822] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Bloodstream infections are associated with high mortality rates and contribute substantially to healthcare costs, but a consensus on the prognostic benefits of appropriate empirical antimicrobial therapy (EAT) for bacteraemia is lacking. Methods We performed a systematic search of the PubMed, Cochrane Library, and Embase databases through July 2021. Studies comparing the mortality rates of patients receiving appropriate and inappropriate EAT were considered eligible. The quality of the included studies was assessed using Joanna Briggs Institute checklists. Results We ultimately assessed 198 studies of 89,962 total patients. The pooled odds ratio (OR) for the prognostic impacts of inappropriate EAT was 2.06 (P < 0.001), and the funnel plot was symmetrically distributed. Among subgroups without between-study heterogeneity (I2 = 0%), those of patients with severe sepsis and septic shock (OR, 2.14), Pitt bacteraemia scores of ≥4 (OR, 1.88), cirrhosis (OR, 2.56), older age (OR, 1.78), and community-onset/acquired Enterobacteriaceae bacteraemia infection (OR, 2.53) indicated a significant effect of inappropriate EAT on mortality. The pooled adjusted OR of 125 studies using multivariable analyses for the effects of inappropriate EAT on mortality was 2.02 (P < 0.001), and the subgroups with low heterogeneity (I2 < 25%) exhibiting significant effects of inappropriate EAT were those of patients with vascular catheter infections (adjusted OR, 2.40), pneumonia (adjusted OR, 2.72), or Enterobacteriaceae bacteraemia (adjusted OR, 4.35). Notably, the pooled univariable and multivariable analyses were consistent in revealing the negligible impacts of inappropriate EAT on the subgroups of patients with urinary tract infections and Enterobacter bacteraemia. Conclusion Although the current evidence is insufficient to demonstrate the benefits of prompt EAT in specific bacteraemic populations, we indicated that inappropriate EAT is associated with unfavorable mortality outcomes overall and in numerous subgroups. Prospective studies designed to test these specific populations are needed to ensure reliable conclusions. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42021270274.
Collapse
Affiliation(s)
- Yuan-Pin Hung
- Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan City, Taiwan.,Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan City, Taiwan.,Department of Medicine, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Ching-Chi Lee
- Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan City, Taiwan.,Clinical Medicine Research Centre, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan City, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan City, Taiwan.,Department of Medicine, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| |
Collapse
|
7
|
Antibiotic Administration within Two Days after Successful Endoscopic Retrograde Cholangiopancreatography Is Sufficient for Mild and Moderate Acute Cholangitis. J Clin Med 2022; 11:jcm11102697. [PMID: 35628824 PMCID: PMC9143657 DOI: 10.3390/jcm11102697] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 02/05/2023] Open
Abstract
To prevent the increase of resistant bacteria, it is important to minimize the use of antimicrobial agents. Studies have found that administration for ≤3 days after successful endoscopic retrograde cholangiopancreatography (ERCP) is appropriate. Therefore, the present study aimed to verify if administration of antimicrobial agents can be further shortened to ≤2 days after ERCP. We divided 390 patients with mild and moderate cholangitis who underwent technically successful ERCP from January 2018 to June 2020 and had positive blood or bile cultures into two groups: antibiotic therapy within two days of ERCP (short-course therapy, SCT; n = 59, 15.1%), and for >3 days (long-course therapy, LCT; n = 331, 84.9%). The increased severity after admission and other outcomes were compared between the two groups, and the risk factors for increased severity were verified. There were no between-group differences in patient characteristics. Total length of hospital stay was shorter in SCT than in LCT, and other outcomes in SCT were not significantly different from those in LCT. Being 80 or older was a risk factor for increased severity; however, SCT was not associated with increased severity. Antimicrobial therapy for ≤2 days after successful ERCP is adequate in patients with mild and moderate acute cholangitis.
Collapse
|
8
|
Masuda S, Koizumi K, Uojima H, Kimura K, Nishino T, Tasaki J, Ichita C, Sasaki A. Effect of Antibiotic Resistance of Pathogens on Initial Antibiotic Therapy for Patients With Cholangitis. Cureus 2021; 13:e18449. [PMID: 34650837 PMCID: PMC8487445 DOI: 10.7759/cureus.18449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives Considering that pathogens resistant to initial antibiotic therapies for cholangitis can affect mortality rates, appropriate initial empiric antibiotic therapy is important. However, evidence regarding the influence of pathogens resistant to initial antibiotics in patients with cholangitis who have undergone early endoscopic retrograde cholangiopancreatography (ERCP) is limited, and the conditions in several cases can improve with early ERCP even when pathogens resistant to initial antibiotics are detected on time. Therefore, this study aimed to assess the influence of pathogens resistant to initial antibiotics on the course of cholangitis in patients undergoing early ERCP. Materials and methods Patients (n=266) with positive blood or bile culture results treated with early ERCP were divided into those with cultures that were resistant to the initial antibiotics (antibiotic-resistant group; n=66; 24.8%) and those with cultures that were sensitive to the initial antibiotics (antibiotic-sensitive group; n=200; 75.2%). The duration of hospitalization, in-hospital mortality rates due to cholangitis, rates of increased disease severity, and complications during hospitalization were studied. Results Enterococcus, Enterobacter, Citrobacter, and Pseudomonas species showed high resistance to several antibiotics. No significant between-group differences were found in the duration of hospitalization, in-hospital mortality rates due to cholangitis, and rates of increased disease severity. However, the rate of post-ERCP cholecystitis was significantly higher in the antibiotic-resistant group than in the antibiotic-sensitive group (p=0.0245). Conclusions Even if the initial antibiotics were ineffective, the rate of fatal outcomes did not increase among patients with cholangitis who had undergone early ERCP. However, when initial antibiotics were ineffective, the frequency of post-ERCP cholecystitis increased even after early bile duct decompression.
Collapse
Affiliation(s)
- Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, JPN
| | - Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, JPN
| | - Haruki Uojima
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, JPN
| | - Karen Kimura
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, JPN
| | - Takashi Nishino
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, JPN
| | - Junichi Tasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, JPN
| | - Chikamasa Ichita
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, JPN
| | - Akiko Sasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, JPN
| |
Collapse
|
9
|
Kawamura S, Karasawa Y, Toda N, Nakai Y, Shibata C, Kurokawa K, Arai J, Funato K, Kurosaki S, Maeshima S, Kondo M, Kojima K, Ohki T, Seki M, Koike K, Tagawa K. Impact of the Sensitivity to Empiric Antibiotics on Clinical Outcomes after Biliary Drainage for Acute Cholangitis. Gut Liver 2021; 14:842-849. [PMID: 32050314 PMCID: PMC7667925 DOI: 10.5009/gnl19248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 10/20/2019] [Accepted: 11/03/2019] [Indexed: 12/14/2022] Open
Abstract
Background/Aims Empiric antibiotics are given in combination with biliary drainage for acute cholangitis but sometimes turn out to be insensitive to microorganisms in blood and bile. Clinical outcomes were compared according to sensitivity to microorganisms detected in blood and bile culture to evaluate the impact of sensitivity to empiric antibiotics in cholangitis. Methods Consecutive patients who underwent biliary drainage for acute cholangitis were retrospectively studied. Clinical outcomes such as 30-day mortality, length of hospital stay and high care unit stay, organ dysfunction and duration of fever were compared in three groups: group A (sensitive to both blood and bile culture), group B (sensitive to blood culture alone) and group C (insensitive to both blood and bile culture). Results Eighty episodes of cholangitis were classified according to sensitivity results: 42, 32 and six in groups A, B and C. Escherichia coli and Klebsiella were two major pathogens. There were no significant differences in 30-day mortality rate (7%, 0%, and 0%, p=0.244), length of hospital stay (28.5, 21.0, and 20.5 days, p=0.369), organ dysfunction rate (14%, 25%, and 17%, p=0.500), duration of fever (4.3, 3.2, and 3.5 days, p=0.921) and length of high care unit stay (1.4, 1.2, and 1.7 days, p=0.070) in groups A, B and C. Empiric antibiotics were changed in 11 episodes but clinical outcomes appeared to be non-inferior even in 31 episodes of cholangitis who were on inadequate antibiotics throughout the course. Conclusions Sensitivity of empiric antibiotics was not associated with clinical outcomes in acute cholangitis.
Collapse
Affiliation(s)
- Satoshi Kawamura
- Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yuki Karasawa
- Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Nobuo Toda
- Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yousuke Nakai
- Department of Gastroenterology, University of Tokyo Hospital, Tokyo, Japan
| | - Chikako Shibata
- Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Ken Kurokawa
- Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Junya Arai
- Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Kazuyoshi Funato
- Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan
| | | | - Shuya Maeshima
- Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Mayuko Kondo
- Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Kentaro Kojima
- Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Takamasa Ohki
- Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Michiharu Seki
- Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, University of Tokyo Hospital, Tokyo, Japan
| | - Kazumi Tagawa
- Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan
| |
Collapse
|
10
|
Jang DK, Kim J, Park WB, Yi SY, Lee JK, Yoon WJ. Increasing burden of biliary tract infection caused by extended-spectrum beta-lactamase-producing organisms in Korea: A nationwide population-based study. J Gastroenterol Hepatol 2020; 35:56-64. [PMID: 31359494 DOI: 10.1111/jgh.14809] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Biliary tract infections (BTIs) are a major cause of bacteremia. The prevalence of antibiotic-resistant pathogens in BTI patients is reported to be increasing. We used a nationwide database to evaluate the prevalence of, and risk factors for, BTIs caused by extended-spectrum beta-lactamase-producing organisms (ESBL-PO) in Korea. METHODS Patients with a BTI diagnosis, an admission history, a history of a BTI-related procedure, and antibiotic use for ≥ 4 days between 2007 and 2016 were identified from the Health Insurance Review and Assessment Service database. A BTI treated with carbapenems (BTI-TC) was used as the surrogate for a BTI caused by ESBL-PO. We conducted a multivariate logistic regression analysis to determine the risk factors for BTI-TC. RESULTS In total, 341 002 patients were enrolled. The overall percentage of BTI-TC among BTIs was 2.4%, with an increasing annual trend (P < 0.0001). The risk of acute cholangitis caused by ESBL-PO increased significantly in men, older patients, patients with comorbidities, patients with a history of a biliary procedure within the previous year, and patients with a history of antibiotic use within the previous 90 days. Regarding antibiotic use, the patients at highest risk were those previously prescribed carbapenems (adjusted odds ratio, 4.77; P < 0.0001). CONCLUSIONS The prevalence of BTIs caused by ESBL-PO has increased during the last 10 years. Initial carbapenem therapy should be considered for elderly patients with acute cholangitis if they have had a previous biliary procedure and/or a history of carbapenem administration within the previous 90 days.
Collapse
Affiliation(s)
- Dong Kee Jang
- Department of Internal Medicine, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jungmee Kim
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sun Young Yi
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Jun Kyu Lee
- Department of Internal Medicine, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Won Jae Yoon
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| |
Collapse
|
11
|
Kim SH, Oh S, Huh K, Cho SY, Kang CI, Chung DR, Peck KR. Inappropriate empirical antibiotic therapy does not adversely affect the clinical outcomes of patients with acute pyelonephritis caused by extended-spectrum β-lactamase-producing Enterobacteriales. Eur J Clin Microbiol Infect Dis 2019; 38:937-944. [PMID: 30868326 DOI: 10.1007/s10096-019-03528-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/01/2019] [Indexed: 12/12/2022]
Abstract
Extended-spectrum β-lactamase-producing Enterobacteriales (ESBL-PE) are often associated with inappropriate empirical therapy (IAT). The aim of this study was to investigate whether IAT of acute pyelonephritis (APN) caused by ESBL-PE is related to adverse outcomes. A retrospective cohort study was performed at a tertiary-care hospital from 2014 through 2016. Patients who had APN caused by ESBL-PE and were definitely treated with appropriate antibiotics for at least 7 days were enrolled. IAT was defined as when inappropriate empirical antibiotics were given 48 h or longer after initial diagnosis of APN. Primary endpoint was treatment failure defined as clinical and/or microbiologic failure. Secondary endpoints were length of hospital stay and recurrence of APN. Propensity score matching was used to adjust heterogeneity of each group. Among 175 eligible cases, 59 patients received IAT and 116 patients received appropriate empirical antimicrobial therapy (AT). Treatment failure was observed in five (8.4%) patients and nine (7.8%) patients in each group, respectively. After matching, the treatment failure rate was similar between both groups (adjusted odd ratio [aOR] 1.05; 95% confidence index [CI] 0.26-4.15). The length of hospital stay (median 11 days in the IAT group versus 11 days in the AT group; P = 0.717) and absence of recurrence within 2 months (90.3% in IAT and 86.7% in AT; P = 0.642) were also similar. IAT did not adversely affect the clinical outcome. In this regard, clinicians should be more cautious about indiscriminate prescription of broad-spectrum antibiotics such as carbapenem empirically for treatment of APN possibly caused by ESBL-PE.
Collapse
Affiliation(s)
- Si-Ho Kim
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, (06351) 81 Irwon-ro, Gangnam-gu, Seoul, South Korea
| | - Suhyun Oh
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, (06351) 81 Irwon-ro, Gangnam-gu, Seoul, South Korea
| | - Kyungmin Huh
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, (06351) 81 Irwon-ro, Gangnam-gu, Seoul, South Korea
| | - Sun Young Cho
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, (06351) 81 Irwon-ro, Gangnam-gu, Seoul, South Korea
| | - Cheol-In Kang
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, (06351) 81 Irwon-ro, Gangnam-gu, Seoul, South Korea
| | - Doo Ryeon Chung
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, (06351) 81 Irwon-ro, Gangnam-gu, Seoul, South Korea
| | - Kyong Ran Peck
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, (06351) 81 Irwon-ro, Gangnam-gu, Seoul, South Korea.
| |
Collapse
|
12
|
Tagashira Y, Sakamoto N, Isogai T, Hikone M, Kosaka A, Chino R, Higuchi M, Uehara Y, Honda H. Impact of inadequate initial antimicrobial therapy on mortality in patients with bacteraemic cholangitis: a retrospective cohort study. Clin Microbiol Infect 2017; 23:740-747. [PMID: 28254686 DOI: 10.1016/j.cmi.2017.02.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/16/2017] [Accepted: 02/22/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Acute cholangitis is a common cause of bacteraemia resulting in severe sepsis or septic shock. The impact of the appropriate initial antimicrobial therapy on short-term mortality in bacteraemic cholangitis has not been well investigated. METHODS We conducted a retrospective cohort study of patients with bacteraemic cholangitis at two large tertiary care centres in Tokyo, Japan between 2009 and 2015. We determined the factors associated with 30-day all-cause mortality from the date of drawing the first positive blood culture, using a multivariate logistic regression analysis. RESULTS We identified 573 patients with bacteraemic cholangitis (median age, 77 years; male, 58.3%). The 30-day all-cause mortality rate was 6.6% (38/573). Inadequate initial antimicrobial therapy occurred in 133 (23.2%) patients. Factors associated with 30-day all-cause mortality included the Charlson co-morbidity index score >3 (adjusted odds ratio (aOR) 4.12; 95% CI 1.18-14.38), jaundice (total bilirubin >2.5 mg/dL) (aOR 3.39; 95% CI 1.46-7.89), septic shock within 48 h of the first positive blood culture (aOR 3.34; 95% CI 1.42-7.89), biliary obstruction due to hepatobiliary malignancy (aOR 8.00; 95% CI 2.92-21.97), and inadequate initial antimicrobial therapy (aOR 2.78; 95% CI 1.27-6.11). CONCLUSIONS Inadequate initial antimicrobial therapy was an important, modifiable determinant of survival.
Collapse
Affiliation(s)
- Y Tagashira
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan; Department of Infection Control Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - N Sakamoto
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan
| | - T Isogai
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - M Hikone
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan
| | - A Kosaka
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan
| | - R Chino
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - M Higuchi
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Y Uehara
- Department of Infection Control Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - H Honda
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
| |
Collapse
|
13
|
Cho SY, Kang CI, Cha MK, Wi YM, Ha YE, Chung DR, Lee NY, Peck KR, Song JH. Clinical Features and Treatment Outcomes of Bloodstream Infections Caused by Extended-Spectrum β-Lactamase-Producing Escherichia coli Sequence Type 131. Microb Drug Resist 2015; 21:463-9. [PMID: 25756854 DOI: 10.1089/mdr.2014.0261] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite the remarkable emergence of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli sequence type 131 (ST131), the clinical features and outcomes of infections caused by ST131 remain poorly described. From 2011 to 2012, we collected ESBL-producing E. coli isolates from patients with bloodstream infections in 13 hospitals in Korea and compared clinical characteristics and outcomes between ST131 and non-ST131 clones. Of the 110 ESBL-producing isolates, the most common ST was ST131 (30.9%). Multivariate analysis showed that recent operation was the only variable associated with the ST131 clone; other comorbid conditions and clinical features were similar between ST131 and non-ST131 clones. CTX-M-14 and CTX-M-15 were the predominant types of ESBLs, and CTX-M-15 was significantly associated with ST131. The rate of nonsusceptibility to ciprofloxacin was higher in ST131 than in non-ST131 clones (94.1% vs. 75.0%). No significant differences in 30-day mortality rates were found between ST131 and non-ST131 clones. Multivariate analysis revealed that older age (odds ratio [OR]=5.39, 95% confidence interval [CI] 1.22-23.89; p=0.027), nosocomial infection (OR=4.81, 95% CI 1.15-20.15; p=0.032), and higher Pitt bacteremia score (OR=7.26, 95% CI 1.41-37.42; p=0.018) were independent risk factors for 30-day mortality. The ESBL-producing E. coli ST131 clone has emerged and disseminated in Korea. Our findings reveal similarities in clinical and demographic characteristics between ST131 and non-ST131 clones. Although a more resistant profile has been detected in ST131, patients with the ST131 clone did not exhibit a higher mortality rate.
Collapse
Affiliation(s)
- Sun Young Cho
- 1 Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Cheol-In Kang
- 1 Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Min Kyeong Cha
- 2 Asia Pacific Foundation for Infectious Diseases (APFID) , Seoul, Korea
| | - Yu Mi Wi
- 3 Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine , Changwon, Korea
| | - Young Eun Ha
- 1 Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Doo Ryeon Chung
- 1 Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Nam Yong Lee
- 4 Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Kyong Ran Peck
- 1 Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Jae-Hoon Song
- 1 Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea.,2 Asia Pacific Foundation for Infectious Diseases (APFID) , Seoul, Korea
| | | |
Collapse
|
14
|
Ha YE, Kang CI, Cha MK, Park SY, Wi YM, Chung DR, Peck KR, Lee NY, Song JH. Epidemiology and clinical outcomes of bloodstream infections caused by extended-spectrum β-lactamase-producing Escherichia coli in patients with cancer. Int J Antimicrob Agents 2013; 42:403-9. [PMID: 24071027 DOI: 10.1016/j.ijantimicag.2013.07.018] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/23/2013] [Accepted: 07/26/2013] [Indexed: 11/25/2022]
Abstract
Patients with cancer can be vulnerable to infection with antimicrobial-resistant pathogens such as extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. A cohort study was performed to evaluate the epidemiology and impact of ESBL-producing Escherichia coli (ESBL-EC) bacteraemia on the outcomes of adult patients with cancer. During the 2.5-year study period, a total of 350 cases of E. coli bacteraemia were documented in cancer patients, of which 95 (27.1%) were due to ESBL-EC. Significant factors associated with ESBL-EC bacteraemia were liver disease, immunosuppressant use, recent surgery, and prior use of cephalosporins or fluoroquinolones. The overall 30-day mortality rate was 14.9% (52/350), and the mortality rate was higher in patients with ESBL-EC than in those without ESBL-EC (22.1% vs.12.2%; P=0.02). Multivariate analysis showed that ESBL-EC was an independent risk factor for mortality (odds ratio=3.01, 95% confidence interval 1.45-6.28; P=0.003), along with the presence of septic shock, mechanical ventilation, the severity of underlying diseases, and pneumonia as a source of bacteraemia. Of the 69 isolates in which ESBLs and their molecular relationships were studied, 68 (98.6%) produced CTX-M-type and 51 (73.9%) produced CTX-M-14 and/or CTX-M-15. Twenty-four sequence types (STs) were identified among CTX-M-14- and CTX-M-15-producing E. coli isolates, with ST131 being the most prevalent (12/51; 23.5%). In conclusion, this study confirms that CTX-M-producing E. coli and ST131, which have been shown to be an emerging public health threat, are widely prevalent in cancer patients and can adversely affect the outcome of E. coli bacteraemia in these patients.
Collapse
Affiliation(s)
- Young Eun Ha
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul 135-710, Republic of Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Bang JH, Jung Y, Cheon S, Kim CJ, Song KH, Choe PG, Park WB, Kim ES, Park SW, Kim HB, Oh MD, Lee HS, Kim NJ. Pseudomonas aeruginosa bacteremia in patients with liver cirrhosis: a comparison with bacteremia caused by Enterobacteriaceae. BMC Infect Dis 2013; 13:332. [PMID: 23870005 PMCID: PMC3720192 DOI: 10.1186/1471-2334-13-332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 07/17/2013] [Indexed: 11/16/2022] Open
Abstract
Background This study was performed to detect risk factors for Pseudomonas aeruginosa bacteremia in patients with liver cirrhosis. Methods A retrospective case–control study was designed to identify risk factors for P. aeruginosa bacteremia in cirrhotic patients. The cases were cirrhotic patients with P. aeruginosa bacteremia and the controls were cirrhotic patients with Enterobacteriaceae bacteremia. Results Sixty-one cases and the same number of controls were enrolled. In a multivariate analysis, younger age {adjusted odds ratio (aOR) per one year: 0.96, 95% confidence interval: 0.93 - 0.99}, nosocomial acquisition (aOR 3.87, 95% confidence interval: 1.50 - 9.94), preexisting biliary disease (aOR 4.79, 95% confidence interval: 1.92 - 10.47), and recent exposure to immunosuppressive agent (aOR 3.10, 95% confidence interval: 1.23 - 7.82) were associated with P. aeruginosa bacteremia. In the case group the frequency of appropriate initial antibiotic regimens was considerably lower than in the control group: 29.5% vs. 65.6% (P <0.01). However, thirty day mortality did not differ significantly between cases and controls (19.7% vs. 24.6%). Conclusions Nosocomial acquisition, preexisting biliary disease, and recent use of immunosuppressive agents are strong predictive factors for P. aeruginosa bacteremia in cirrhotic patients.
Collapse
Affiliation(s)
- Ji Hwan Bang
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, 110-744, Seoul, Republic of Korea
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|