Changes in Causative Pathogens of Acute Cholangitis and Their Antimicrobial Susceptibility over a Period of 6 Years.
10.4166/kjg.2014.63.5.299
- Author:
Jeong Seok KWON
1
;
Jimin HAN
;
Tae Won KIM
;
Ji Hye OH
;
Hyun Hee KWON
;
Jin Tae JUNG
;
Joong Goo KWON
;
Eun Young KIM
;
Ho Gak KIM
Author Information
1. Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea. mhan@cu.ac.kr
- Publication Type:Original Article
- Keywords:
Cholangitis;
Microbial sensitivity tests;
Antimicrobial drug resistance
- MeSH:
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
- From:The Korean Journal of Gastroenterology
2014;63(5):299-307
- CountryRepublic of Korea
- Language:English
-
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.
