Comparative analysis of microbiological profiles and antibiotic resistance patterns from bile samples obtained during endoscopic retrograde cholangiopancreatography in patients with acute cholangitis: a prospective multinational study

Aims The high complexity of current biliopancreatic procedures and the growing prevalence of multidrug-resistant (MDR) organisms often complicate the management of patients with acute cholangitis (AC) [1]. Simultaneously, significant differences in antibiotic resistance (AR) rates exists between different countries or regions, due to cultural differences and varying attitudes towards antibiotic use. For this reason, international recomandations are often unadapted to the current epidemiological situation [2] [3]. We aim to characterize and compare the biliary pathogen spectrum and AR patterns in patients with AC from two large tertiary centers in Romania and France.

Methods We conducted a prospective, observational, multicentre study including patients diagnosed with AC according to the Tokyo 2018 criteria, admitted to the Gastroenterology Department of Colentina Clinical Hospital (CCH), Bucharest, Romania between April 2022 and August 2024, and to the Hepato-Gastroenterology Department of Haut Leveque Hospital (HLH), Bordeaux, France, between May and November 2023. All patients had a positive bile culture and afferent antibiogram collected during endoscopic retrograde cholangiopancreatography (ERCP), and antibiotic treatment was initiated in less than 48 hours before the procedure.

Results We included a total of 144 patients (83 males, mean age 70 years) from HCC, with 190 positive bilicultures and 241 identified bacteria, and 61 patients (39 males, mean age 71 years) from HLH, with 194 identified bacteria. In the CCH group, the most common cause was choledocholithiasis (32.63%), followed by Klatskin's tumour (23.61%) and pancreatic head cancer (16.66%). In the HLH group, pancreatic head cancer was the most common cause (31.14%), followed by Klatskin's tumour (16.39%). The most frequently isolated bacteria were Escherichia coli (74/30.70%) and Pseudomonas spp. (67/27.80%) in the CCH group, and Enterococcus faecalis (30/15.46%), Escherichia coli (22/11.34%) and Enterobacter cloacae (16/8.24%) in the HLH group. Furthermore, 51 (21.16%) of the bacteria identified in the CCH group and 14 (7.21%) in the HLH group were MDR bacteria, such as Enterococcus faecalis HLAR, Enterococcus faecium VRE, Escherichia coli ESBL, or Staphylococcus haemolyticus MLS. AR rates for popular antibiotics were 13.69% in HCC group vs. 8.76% in HLH group for ceftriaxone, 9.54% vs. 2.06% for meropenem, 16.59% vs. 6.70% for piperacillin/tazobactam and 25.31% vs. 7.73% for levofloxacin.

Conclusions This comparative study shows significant differences between these countries, in terms of the main aetiological agents involved, antibiotic resistance rates and the prevalence of MDR bacteria. Bile sample culture and antibiotic susceptibility testing is a safe, rapid and cost-effective method for guiding antibiotic treatment, thereby reducing antibiotic resistance rates, complications, and associated costs in patients with AC.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Kaya M, Beştaş R, Bacalan F, Bacaksız F, Arslan EG, Kaplan MA.. Microbial profile and antibiotic sensitivity pattern in bile cultures from endoscopic retrograde cholangiography patients. World J Gastroenterol 2012; 18 (27): 3585-9
• 2 Chandra S, Klair JS, Soota K, Livorsi DJ, Johlin FC.. Endoscopic Retrograde Cholangio-Pancreatography-Obtained Bile Culture Can Guide Antibiotic Therapy in Acute Cholangitis. Dig Dis 2019; 37 (02): 155-160
• 3 Miutescu B, Vuletici D, Burciu C, Bende F, Ratiu I, Moga T, Gadour E, Reddy S, Sandru V, Balan G. et al. Comparative Analysis of Microbial Species and Multidrug Resistance Patterns in Acute Cholangitis Patients with Cholecystectomy: A Single-Center Study. Diseases 2024; 12: 19