Endoscopy 2018; 50(04): S14-S15
DOI: 10.1055/s-0038-1637067
ESGE Days 2018 oral presentations
20.04.2018 – Best care session 1
Georg Thieme Verlag KG Stuttgart · New York

INCREASED RESISTANCE AGAINST CIPROFLOXACINE AND METRONIDAZOLE IN CHOLANGITIS

D Illés
1   University of Szeged, Szeged, Hungary
,
L Czakó
1   University of Szeged, Szeged, Hungary
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

 

Aims:

To investigate the AB resistance of bacteria causing cholangitis and the efficacy of AB treatment.

Methods:

Microbiological tests of bile samples collected during ERCP performed in patients with cholestasis and cholangitis were analysed at the First Department of Internal Medicine, University of Szeged, in 2006 and in 2016 as follows: rate of positive samples, type of pathogens, AB-resistance and efficacy of empirical AB treatment.

Results:

29 and 111 patients had bile sample collection in 2006 and in 2016, respectively. Of that, 22 (75%) and 106 (95%) were positive. The mean age of patients were 61 ± 14 vs. 71 ± 14 years with no difference of gender. In 2006, 10 cases empirical AB (9 cases ciprofloxacine+metronidazole and imipenem in 1 case) were used. In 9 cases (90%) the AB was adequate based on the microbiological results. In 2016, in 88 cases empirical AB was applied (53 cases ciprofloxacine and metronidazole and 16 – 16 cases ceftriaxone and metronidazole/imipenem and metronidazole, 4 cases other). In 29 cases (33%) the empirical AB was shown ineffective by the microbiological tests, but in 50% of these cases, an effective empirical escalation in AB was implemented before knowing the result of the microbiological test. The efficacy of the most used ciprofloxacine+metronidazole decreased from 89% (2006) to 64% (2016). The profile of the most frequent pathogens causing cholangitis was the same (E. Coli, Enterococcus faecalis, Klebsiella pneumoniae, Pseudomonas aeruginosa, Clostridium perfringens), but new pathogens (Candida albicans, Achromobacter sp.) were present in 2016 beside them. The rate of polymicrobal infections were 73% and 63% in 2006 and in 2016, respectively.

Conclusions:

The rate of positive bile samples were significantly higher in 2016, than in 2006. Among the pathogens causing cholangitis in 2016, new species appeared as compared to 2006. The efficacy of first-choice empirical AB combination ciprofloxacine-metronidazole decreased in 2016.