Endoscopy 2025; 57(S 02): S98-S99
DOI: 10.1055/s-0045-1805289
Abstracts | ESGE Days 2025
Oral presentation
Bugs in the bile: what to expect and how to treat 04/04/2025, 11:30 – 12:30 Room 124+125

Microbiological Spectrum, Antibiotic Resistance, and Clinical Outcomes in Acute Cholangitis: A Prospective Single-Center Study

Authors

  • B Başpınar

    1   Kilis Prof.Dr.Alaeddin Yavaşca Devlet Hastanesi, Kilis, Türkiye

  • ÇM Ayaz

    2   Akdeniz Üniversitesi Hastanesi, Antalya, Türkiye

  • B ÖDemiş

    3   University of Health Sciences, Ankara City Hospital, Ankara, Türkiye
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    Aims Acute cholangitis(AC) is a serious biliary infection. While antibiotic treatment is crucial, the variability in bacterial profiles and rising antibiotic resistance complicate the management. This study aimed to assess the clinical and microbiological characteristics of AC patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) among AC severity groups.

    Methods This study prospectively included 118 adult patients diagnosed with AC from November 2020 to September 2022. Bile samples for bacterial analysis were collected during ERCP. Data on demographics, bile and blood cultures, and clinical outcomes such as intensive care need and mortality were analyzed.

    Results All bile cultures were positive, with 213 bacterial strains isolated: 57.7% gram-negative and 42.3% gram-positive. The most frequent bacteria were Escherichia coli(23.0%), Enterococcus spp.(19.2%), Klebsiella spp.(17.8%), and Viridans group Streptococci(14.5%). Extended-spectrum beta-lactamase(ESBL) resistance was found in 63.3% of E.coli and 56.7% of K.pneumoniae. Carbapenem resistance was in 6.1% of E.coli and 33.3% of K.pneumoniae and Pseudomonas aeruginosa. Polymicrobial infections were present in 65.3% of cases, particularly in moderate cholangitis(p=0.02). Klebsiella spp.-related infections were more prevalent in patients with biliary stent(p=0.03). ESBL-producing and carbapenem-resistant microorganisms were higher in patients with a history of ERCP(p=0.005 and p=0.04, respectively). Similarly, the incidence of ESBL-producing microorganisms was elevated in patients with biliary stent(p=0.003). Patients with severe cholangitis had higher intensive care unit admission rates (72.0%, p=0.02) and mortality (20.0%, p=0.003).

    Conclusions Local microbiological pattern and antibiotic resistance is critical in AC management. Previous history of ERCP and the presence of biliary prosthesis showed more complex microbiological profiles and higher antimicrobial drug resistance, necessitating careful selection of antibiotics.


     

    Conflicts of Interest

    Authors do not have any conflict of interest to disclose.

    Publication History

    Article published online:
    27 March 2025

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