Endoscopy 2025; 57(S 02): S648
DOI: 10.1055/s-0045-1806702
Abstracts | ESGE Days 2025
ePosters

Evaluating Antimicrobial Resistance in Acute Cholangitis Patients from the ARISE Trial in Romanian Tertiary Centers

Autoren

  • B Miutescu

    1   Department of Gastroenterology and Hepatology, “Victor Babes”, Timișoara, Romania

  • G Balan

    2   Universitatea de Medicină și Farmacie „Grigore T. Popa” din Iași, Iași, Romania

  • D Vuletici

    3   Victor Babeş University of Medicine and Pharmacy, Timișoara, Romania

  • F Bratosin

    3   Victor Babeş University of Medicine and Pharmacy, Timișoara, Romania

  • G Deniz

    4   Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania, Bucharest, Romania

  • S Zenovia

    2   Universitatea de Medicină și Farmacie „Grigore T. Popa” din Iași, Iași, Romania

  • V Sandru

    5   Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, Bucharest, Romania
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Aims The global trend with increasing incidence of multidrug resistant (MDR) pathogens represents one of the most important medical emergencies. Acute cholangitis is frequently complicated by resistant biliary infections, mostly from the GI tract, challenging clinical management and outcomes [1]. We aimed to characterize the antimicrobial resistance patterns in a multicentric study, and to identify risk factors for MDR pathogens.

Methods The ARISE trial currently takes place in three tertiary endoscopy units from Romania. As of August 2024, a total of 498 adult patients with acute cholangitis were included after disease confirmation by clinical, laboratory, and imaging findings described in the Tokyo guidelines. https://clinicaltrials.gov/study/NCT06197984

Results Overall, 60.1% of biliary cultures were positive, with 35.2% of them being polymicrobial. Blood cultures were obtained in 76.9% of patients, of which 11.5% were positive. The three most frequently isolated organisms included Escherichia coli (41.4%), Klebsiella pneumoniae (22.6%), and Pseudomonas aeruginosa (16.5%). Among isolated strains, 28.0% demonstrated at least one significant resistance, with extended-spectrum beta-lactamase (ESBL) production (24.9%), methicillin-resistant Staphylococcus aureus (MRSA) (10.6%), and vancomycin-resistant enterococci (VRE) (8.8%) topping the resistance patterns. MDR, defined as resistance to three or more antibiotic classes, was detected in 17.4% of positive cultures.Patients with MDR pathogens were older (mean age 71.2 vs. 63.8 years, p<0.01) and more likely to have diabetes mellitus (34.2% vs. 18.6%, p<0.05). Tokyo severity grade II (29.5%) or III (19.3%) was significantly associated with MDR involvement (22.0% vs. 9.7%, p<0.01). Prolonged prior antibiotic exposure (over 48 hours) was independently predictive of MDR growth (adjusted odds ratio 2.4, 95% CI 1.6–3.6). In-hospital mortality was higher in patients with MDR isolates (15.8% vs. 4.4%, p<0.01), underscoring the clinical impact of resistance

Conclusions Antibiotic resistance in acute cholangitis remains substantial, especially among advanced Tokyo severity cases. Recognizing risk factors, including older age, prior antibiotic use, and severe disease, can guide empiric treatment strategies to mitigate the burden of MDR pathogens and improve outcomes.



Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

© 2025. European Society of Gastrointestinal Endoscopy. All rights reserved.

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  • References

  • 1 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
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