Pathogen patterns and clinical outcomes of empirical antibiotic treatment in cholangitis: Single-center retrospective study
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This retrospective cohort study determines patterns of pathogens and empirical antibiotic treatment among patients with cholangitis. We examined the clinical response and in-hospital all-cause mortality between empirical antibiotic treatment among patients with acute cholangitis at a general hospital in northeast Thailand. The Nelson-Aalen estimator and the Kaplan-Meier survival curve were respectively used to calculate the hazard ratio (HR) and 95% confidence interval (95% CI). The prevalence of pathogens and patterns of empirical antibiotics used were also studied. Among 232 patients, 90 patients (38.8%) had positive blood/bile cultures with 107 pathogenic organisms. The most prevalent non-resistant bacteria were Escherichia coli (35.5%) and Klebsiella pneumoniae (11.2%), to which all were susceptible to ceftriaxone and meropenem. About 16.8% of E. coli isolates exhibited ceftriaxone resistance, but all were sensitive to carbapenems. No difference was noted in clinical response and mortality rates between carbapenem-based and cephalosporin-based regimens (adjusted HR (aHR), 0.88; 95% CI, 0.66–1.19; p = 0.42 and 0.36; 95% CI 0.10–1.28; p = 0.12, respectively). In empirical antibiotic treatment of acute cholangitis, a carbapenem-based regimen demonstrated the same clinical response and mortality rate as a cephalosporin-based regimen; however, carbapenems should only be used among patients at high risk of resistant infections.
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