Association of short-course antimicrobial therapy and bacterial resistance in acute cholangitis: Retrospective cohort study

Abstract

Background and study aims Although the number of resistant bacteria tends to increase with prolonged antimicrobial therapy, no studies have examined the relationship between the duration of antimicrobial therapy and increase in the number of resistant bacteria in acute cholangitis. We hypothesized that the short-term administration of antimicrobial agents in acute cholangitis would suppress bacterial resistance.

Patients and methods This was a single-center, retrospective, observational study of patients with acute cholangitis admitted between January 2018 and June 2020 who met the following criteria: successful biliary drainage, positive blood or bile cultures, bacteria identified from cultures sensitive to antimicrobials, and subsequent cholangitis recurrence by January 2022. The patients were divided into two groups: those whose causative organisms at the time of recurrence became resistant to the antimicrobial agents used at the time of initial admission (resistant group) and those who remained susceptible (susceptible group). Multivariate analysis was used to examine risk factors associated with the development of resistant pathogens. Multivariate analysis investigated antibiotics used with the length of 3 days or shorter after endoscopic retrograde cholangiopancreatography (ERCP) and previously reported risk factors for the development of bacterial resistance.

Results In total, 89 eligible patients were included in this study. There were no significant differences in patient background or ERCP findings between the groups. The use of antibiotics, completed within 3 days after ERCP, was associated with a lower risk of developing bacterial resistance (odds ratio, 0.17; 95% confidence interval, 0.04–0.65; P=0.01).

Conclusions In acute cholangitis, the administration of antimicrobials within 3 days of ERCP may suppress the development of resistant bacteria.

Keywords

ERC topics - Strictures - Pancreatobiliary (ERCP/PTCD) - Stones

Publication History

Received: 16 August 2023

Accepted after revision: 08 December 2023

Article published online:
28 February 2024

• References

• 1 Caron WP, Mousa SA. Prevention strategies for antimicrobial resistance: a systematic review of the literature. Infect Drug Resist 2010; 3: 25-33
• 2 Morris S, Cerceo E. Trends, epidemiology, and management of multi-drug resistant gram-negative bacterial infections in the hospitalized setting. Antibiotics (Basel) 2020; 9
• 3 Spellberg B, Guidos R, Gilbert D. et al. The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clin Infect Dis 2008; 46: 155-164
• 4 Mölstad S, Erntell M, Hanberger H. et al. Sustained reduction of antibiotic use and low bacterial resistance: 10-year follow-up of the Swedish Strama programme. Lancet Infect Dis 2008; 8: 125-132
• 5 American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005; 171: 388-416
• 6 Dubin K, Pamer EG. Enterococci and their interactions with the intestinal microbiome. Microbiol Spectr 2014; 5
• 7 Zervos MJ, Terpenning MS, Schaberg DR. et al. High-level aminoglycoside-resistant enterococci. Colonization of nursing home and acute care hospital patients. Arch Intern Med 1987; 147: 1591-1594
• 8 Zhou X, Willems RJL, Friedrich AW. et al. Enterococcus faecium: from microbiological insights to practical recommendations for infection control and diagnostics. Antimicrob Resist Infect Control 2020; 9: 130
• 9 Buhl M, Peter S, Willmann M. Prevalence and risk factors associated with colonization and infection of extensively drug-resistant Pseudomonas aeruginosa: a systematic review. Expert Rev Anti Infect Ther 2015; 13: 1159-1170
• 10 Tetsuka N, Hirabayashi A, Matsumoto A. et al. Molecular epidemiological analysis and risk factors for acquisition of carbapenemase-producing Enterobacter cloacae complex in a Japanese university hospital. Antimicrob Resist Infect Control 2019; 8: 126
• 11 Hakuta R, Nakai Y, Hamada T. et al. Use of proton pump inhibitors and cholangitis complicated with multi-drug resistant bacteria. J Hepatobiliary Pancreat Sci 2022; 29: 230-238
• 12 Reuken PA, Torres D, Baier M. et al. Risk factors for multi-drug resistant pathogens and failure of empiric first-line therapy in acute cholangitis. PLoS One 2017; 12: e0169900
• 13 Schneider J, De Waha P, Hapfelmeier A. et al. Risk factors for increased antimicrobial resistance: a retrospective analysis of 309 acute cholangitis episodes. J Antimicrob Chemother 2014; 69: 519-525
• 14 Karasawa Y, Kato J, Kawamura S. et al. Risk factors for acute cholangitis caused by Enterococcus faecalis and Enterococcus faecium. Gut Liver 2021; 15: 616-624
• 15 Gromski MA, Gutta A, Lehman GA. et al. Microbiology of bile aspirates obtained at ERCP in patients with suspected acute cholangitis. Endoscopy 2022; 54: 1045-1052
• 16 Chastre J, Wolff M, Fagon J-Y. et al. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA 2003; 290: 2588-2598
• 17 Singh N, Rogers P, Atwood CW. et al. Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. A proposed solution for indiscriminate antibiotic prescription. Am J Respir Crit Care Med 2000; 162: 505-511
• 18 Lai C-C, Chen S-Y, Ko W-C. et al. Increased antimicrobial resistance during the COVID-19 pandemic. Int J Antimicrob Agents 2021; 57: 106324
• 19 Teshome BF, Vouri SM, Hampton N. et al. Duration of exposure to antipseudomonal β-lactam antibiotics in the critically ill and development of new resistance. Pharmacotherapy 2019; 39: 261-270
• 20 Wintenberger C, Guery B, Bonnet E. et al. Proposal for shorter antibiotic therapies. Med Mal Infect 2017; 47: 92-141
• 21 Spellberg B. The new antibiotic mantra-"shorter is better". JAMA Intern Med 2016; 176: 1254-1255
• 22 Melzer M, Toner R, Lacey S. et al. Biliary tract infection and bacteraemia: presentation, structural abnormalities, causative organisms and clinical outcomes. Postgrad Med J 2007; 83: 773-776
• 23 Esposito AL, Gleckman RA, Cram S. et al. Community-acquired bacteremia in the elderly: analysis of one hundred consecutive episodes. J Am Geriatr Soc 1980; 28: 315-319
• 24 Gomi H, Solomkin JS, Schlossberg D. et al. Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 2018; 25: 3-16
• 25 Haal S, Wielenga MCB, Fockens P. et al. Antibiotic therapy of 3 days may be sufficient after biliary drainage for acute cholangitis: a systematic review. Dig Dis Sci 2021; 66: 4128-4139
• 26 Satake M, Yamaguchi Y. Three-day antibiotic treatment for acute cholangitis due to choledocholithiasis with successful biliary duct drainage: A single-center retrospective cohort study. Int J Infect Dis 2020; 96: 343-347
• 27 Masuda S, Koizumi K, Makazu M. et al. Antibiotic Administration within Two days after successful endoscopic retrograde cholangiopancreatography is sufficient for mild and moderate acute cholangitis. J Clin Med Res 2022; 11
• 28 Kogure H, Tsujino T, Yamamoto K. et al. Fever-based antibiotic therapy for acute cholangitis following successful endoscopic biliary drainage. J Gastroenterol 2011; 46: 1411-1417
• 29 Sieswerda E, Bax HI, Hoogerwerf JJ. et al. The 2021 Dutch Working Party on Antibiotic Policy (SWAB) guidelines for empirical antibacterial therapy of sepsis in adults. BMC Infect Dis 2022; 22: 687
• 30 Limmathurotsakul D, Netinatsunton N, Attasaranya S. et al. Su1663 An open-labeled, randomized controlled trial comparing between short duration and standard 14 days antibiotic treatments for acute cholangitis in patients with common bile duct stone after successful endoscopic biliary drainage. a preliminary report. Gastrointest Endosc 2014; 79: AB358
• 31 Humphries R, Bobenchik AM, Hindler JA. et al. Overview of changes to the Clinical and Laboratory Standards Institute Performance Standards for Antimicrobial Susceptibility Testing, M100, 31st Edition. J Clin Microbiol 2021; 59: e0021321
• 32 Haddad SF, Allaw F, Kanj SS. Duration of antibiotic therapy in Gram-negative infections with a particular focus on multidrug-resistant pathogens. Curr Opin Infect Dis 2022; 35: 614-620
• 33 Kiriyama S, Kozaka K, Takada T. et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 2018; 25: 17-30
• 34 Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant 2013; 48: 452-458
• 35 O’Neill J. Tackling drug-resistant infections globally: final report and recommendations. Accessed January 01, 2000 at: https://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf
• 36 Ding D, Wang B, Zhang X. et al. The spread of antibiotic resistance to humans and potential protection strategies. Ecotoxicol Environ Saf 2023; 254: 114734
• 37 Costelloe C, Metcalfe C, Lovering A. et al. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ 2010; 340: c2096