ArticlePloS one2017
Risk Factors for Multi-Drug Resistant Pathogens and Failure of Empiric First-Line Therapy in Acute Cholangitis.
Article in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 35 papers, 1 of them a synthesis that pooled it.
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Who cites it
35 citing papers in PubMed, 1 synthesis or guideline pooled it, 58 citations in OpenAlex.
- Microbiology and antimicrobial resistance in biliary tract infections including acute and post-ERCP cholangitis: a systematic review and meta-analysis.Annals of Saudi medicinePooled it
- Antibiotic prophylaxis in acute cholecystectomy revisited: results of a double-blind randomised controlled trial.Langenbeck's archives of surgery · 2020Trial
- Comparison of effectiveness and safety of cefoperazone-sulbactam versus ceftriaxone and flomoxef in acute cholangitis: a multicenter retrospective study.Antimicrobial agents and chemotherapy · 2026Article
- Risk-Adapted Empiric Therapy for Acute Cholangitis: Beyond the Broad- Versus Narrow-Spectrum Dichotomy.Cureus · 2026Article
- Acute Calculous Cholangitis: Causative Aerobic Bacteria and Antibiotic Susceptibility Patterns from a Retrospective Multicenter Study in Vietnam.Life (Basel, Switzerland) · 2026Article
- Article
- Evaluation of microbiological cultures in patients with acute cholecystitis.Frontiers in surgery · 2026Article
- The Evolving Microbiology and Antimicrobial Resistance in Peritonitis of Biliary Origin: An Evidence-Based Update of the Tokyo Guidelines (TG18) for Clinicians.Diagnostics (Basel, Switzerland) · 2025Review
- Prevalence of Bactibilia in Patients Undergoing Cholecystectomy for Gallbladder Diseases: An Observational Study.Cureus · 2025Article
- A Comprehensive Review of Digestive Endoscopy-Associated Infections: Bacterial Pathogens, Host Susceptibility, and the Impact of Viral Hepatitis.Microorganisms · 2025Review
- Microbial Profile and Antibiotic Resistance Patterns in Bile Aspirates from Patients with Acute Cholangitis: A Multicenter International Study.Antibiotics (Basel, Switzerland) · 2025Article
- Navigating antibiotic therapy in acute cholangitis: Best practices and new insights.Journal of hepato-biliary-pancreatic sciences · 2025Review
- Evaluating the frequency and risk factors of multidrug-resistant bacteria in biliary samples.Iranian journal of microbiology · 2024Article
- Acute cholangitis: a state-of-the-art review.Annals of medicine and surgery (2012) · 2024Review
- The role of microbes and parasites in recurrent pyogenic cholangitis.Turkish journal of surgery · 2024Article
- Association of short-course antimicrobial therapy and bacterial resistance in acute cholangitis: Retrospective cohort study.Endoscopy international open · 2024Article
- Comparative Analysis of Microbial Species and Multidrug Resistance Patterns in Acute Cholangitis Patients with Cholecystectomy: A Single-Center Study.Diseases (Basel, Switzerland) · 2024Article
- Comparative Analysis of Antibiotic Resistance in Acute Cholangitis Patients with Stent Placement and Sphincterotomy Interventions.Life (Basel, Switzerland) · 2023Article
- Identification of Microbial Species and Analysis of Antimicrobial Resistance Patterns in Acute Cholangitis Patients with Malignant and Benign Biliary Obstructions: A Comparative Study.Medicina (Kaunas, Lithuania) · 2023Article
- Korean Guidelines for Use of Antibiotics for Intra-abdominal Infections in Adults.Infection & chemotherapy · 2022Review
Corrections and comments
- Erratum issued
Authors and funding
8 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAcute cholangitis (AC) requires the immediate initiation of antibiotic therapy in addition to treatment for biliary obstruction. Against a background of an increasing prevalence of multi-drug resistant (MDR) bacteria, the risk factors for the failure of empiric therapy must be defined.
methodsUsing a pathogen-based approach, 1764 isolates from positive bile duct cultures were retrospectively analyzed to characterize the respective pathogen spectra in two German tertiary centers. Using a patient-based approach, the clinical and laboratory data for 83 patients with AC were assessed to identify risk factors for AC with pathogens resistant to the applied empiric therapy.
resultsBile cultures were predominantly polymicrobial, and empiric antibiotic therapies did not cover the full biliary pathogen spectrum in 78% of cases. MDR bacteria were isolated from the bile of 24/83 (29%) patients. The univariate risk factors for biliary MDR bacteria were male sex, nosocomial AC, prior antibiotic exposure and prior biliary stenting, of which biliary stenting was the only independent risk factor according to multivariate analysis (OR = 3.8; 95% CI 1.3-11.0, P = 0.013). Although there were no significant differences in survival or hospital stay in AC patients with and without detected biliary MDR pathogens, the former more often had a concomitant bloodstream infection (58% vs. 24%; P = 0.019), including those involving MDR pathogens or fungi (21% vs. 2%; P = 0.007).
conclusionPatients with biliary stents who develop AC should receive empiric therapy covering enterococci and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. These patients are at an increased risk for bloodstream infections by MDR pathogens or fungi.
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