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Royo-Cebrecos C, Gudiol C, García J, Tubau F, Laporte J, Ardanuy C, Antonio M, Marin M, Gornals JB, Carratalà J. Characteristics, aetiology, antimicrobial resistance and outcomes of bacteraemic cholangitis in patients with solid tumours: A prospective cohort study. J Infect 2016; 74:172-178. [PMID: 27826062 DOI: 10.1016/j.jinf.2016.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/21/2016] [Accepted: 10/30/2016] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
- C Royo-Cebrecos
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain; REIPI (Spanish Network for Research in Infectious Diseases), Madrid, Spain
| | - C Gudiol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain; Department of Oncology, Institut Català d'Oncologia, l'Hospitalet, University of Barcelona, Barcelona, Spain; REIPI (Spanish Network for Research in Infectious Diseases), Madrid, Spain.
| | - J García
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain
| | - F Tubau
- Department of Microbiology, Hospital Universitari de Bellvitge, IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain
| | - J Laporte
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain
| | - C Ardanuy
- Department of Microbiology, Hospital Universitari de Bellvitge, IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain; CIBERes (CIBER de Enfermedades Respiratorias), ISCIII, Madrid, Spain
| | - M Antonio
- Department of Oncology, Institut Català d'Oncologia, l'Hospitalet, University of Barcelona, Barcelona, Spain
| | - M Marin
- Department of Oncology, Institut Català d'Oncologia, l'Hospitalet, University of Barcelona, Barcelona, Spain
| | - J B Gornals
- Endoscopy Unit, Digestive Disease Department, Hospital Universitari de Bellvitge, IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain; REIPI (Spanish Network for Research in Infectious Diseases), Madrid, Spain
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