Effect of Antibiotic Resistance of Pathogens on Initial Antibiotic Therapy for Patients With Cholangitis

Sakue Masuda; Kazuya Koizumi; Haruki Uojima; Karen Kimura; Takashi Nishino; Junichi Tasaki; Chikamasa Ichita; Akiko Sasaki

doi:10.7759/cureus.18449

Effect of Antibiotic Resistance of Pathogens on Initial Antibiotic Therapy for Patients With Cholangitis

Cureus. 2021 Oct 3;13(10):e18449. doi: 10.7759/cureus.18449. eCollection 2021 Oct.

Authors

Sakue Masuda¹, Kazuya Koizumi¹, Haruki Uojima¹, Karen Kimura¹, Takashi Nishino¹, Junichi Tasaki¹, Chikamasa Ichita¹, Akiko Sasaki¹

Affiliation

¹ Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, JPN.

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.

Keywords: antibacterial agents; antibiotic-resistant pathogens; cholangitis; endoscopic retrograde cholangiopancreatography; post-ercp cholecystitis; risk factors.