Characteristics, aetiology, antimicrobial resistance and outcomes of bacteraemic cholangitis in patients with solid tumours: A prospective cohort study - 18/04/17
, J. García a, F. Tubau b, J. Laporte a, C. Ardanuy b, f, M. Antonio c, M. Marin c, J.B. Gornals d, J. Carratalà a, eSummary |
Objectives |
To asses the clinical features, aetiology, antimicrobial resistance and outcomes of bacteraemic cholangitis in patients with solid tumours (ST).
Methods |
All consecutive episodes of bacteraemia in hospitalized patients were prospectively analysed (2006–2015).
Results |
Of 1852 episodes of bacteraemia, 750 involved patients with ST. Among them, 173 episodes (23%) were due to cholangitis. The most frequent neoplasms were hepato-biliary-pancreatic tumours (68.2%) and gastrointestinal cancer (18.5%); 57.2% of patients had a biliary stent in place. The most frequent causative agents were Escherichia coli (39.3%) followed by Klebsiella pneumoniae (15.1%) and Enterococcus faecium (7.8%). Forty-one episodes (18.7%) were caused by multidrug-resistant (MDR) microorganisms. Patients with a second episode of cholangitis were more likely to have an MDR isolate and to had received inadequate empirical antibiotic therapy. 7-day and 30-day case-fatality rates were 7.6% and 26%, respectively. The only risk factors independently associated with 30-day case-fatality rate were corticosteroids and malignancy-related complications.
Conclusions |
Bacteraemic cholangitis is frequent in patients with ST, and is mainly caused by Enterobacteriaceae and E. faecium. The emergence of MDR is of special concern, particularly in patients with a second episode of bacteraemia. Case-fatality rates are high, especially among patients receiving corticosteroids and presenting malignancy-related complications.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Bacteraemic cholangitis is frequent in patients with solid tumours. |
• | The most frequent causative agents are Enterobacteriaceae and Enterococcus faecium. |
• | Multidrug resistance is more frequent in a second episode of cholangitis. |
• | Corticosteroids and malignancy-related complications present high mortality rates. |
Keywords : Bacteremic cholangitis, Bacteraemia, Bloodstream infection, Cholangitis, Cancer, Solid tumour, Solid neoplasm, Biliopancreatic diseases
Plan
Vol 74 - N° 2
P. 172-178 - février 2017 Retour au numéro
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