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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(02): E307-E316
DOI: 10.1055/a-2230-8229
Original article

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

Sakue Masuda 
1   Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan (Ringgold ID: RIN13619)
,
Ryuhei Jinushi
2   Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan (Ringgold ID: RIN183786)
,
Yoshinori Imamura
3   Division of Medical Oncology/Hematology, Department of Medicine, Kobe University, Kobe, Japan (Ringgold ID: RIN12885)
,
Jun Kubota
1   Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan (Ringgold ID: RIN13619)
,
Karen Kimura
1   Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan (Ringgold ID: RIN13619)
,
Kento Shionoya
1   Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan (Ringgold ID: RIN13619)
,
Makomo Makazu
1   Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan (Ringgold ID: RIN13619)
,
Ryo Sato
1   Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan (Ringgold ID: RIN13619)
,
Makoto Kako
1   Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan (Ringgold ID: RIN13619)
,
Masahiro Kobayashi
1   Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan (Ringgold ID: RIN13619)
,
Haruki Uojima
4   Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan (Ringgold ID: RIN38088)
,
Kazuya Koizumi
1   Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan (Ringgold ID: RIN13619)
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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

Supplementary Material



Publication History

Received: 16 August 2023

Accepted after revision: 08 December 2023

Article published online:
28 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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