Ineffective antibiotic therapy increases mortality of acute cholangitis. The choice of antibiotics should reflect local resistance patterns and avoid the overuse of broad-spectrum agents. In this study, we analysed how results of bile and blood cultures and patient data can be used for selection of empirical antibiotic therapy in acute cholangits. Pathogen frequencies and susceptibility rates were determined in 423 positive bile duct cultures and 197 corresponding blood cultures obtained from 348 consecutive patients with acute cholangitis. Patient data were retrieved from the medical records. Associations of patient and microbiological data were assessed using the Chi-2 test and multivariate binary logistic regression. In bile cultures, enterobacterales and enterococci were isolated with equal frequencies of approximately 30% whereas in blood cultures, enterobacterales predominated (56% compared to 21% enterococci). Antibiotic resistance rates of enterobacterales were > 20% for fluorochinolones, cephalosporines and acylureidopenicillins but not for carbapenems (< 2%). The efficacy of empirical therapy was poor with a coverage of bacterial bile and blood culture isolates in 51 and 69%, respectively. By multivariate analysis, predictors for pathogen species, antibiotic susceptibility and expected antibiotic coverage were identified. In unselected patients treated for acute cholangitis in a large tertiary refferential center, use of carbapenems seems necessary to achieve a high antibiotic coverage. However, by analysis of patient and microbiological data, subgroups for highly effective carbapenem-sparing therapy can be defined. For patients with community-acquired cholangitis without biliary prosthesis who do not need intensive care, piperacillin/tazobactam represents a regimen with an expected excellent antibiotic coverage.

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利用微生物学和患者数据选择急性胆管炎的经验性抗生素治疗

无效的抗生素治疗会增加急性胆管炎的死亡率。抗生素的选择应反映局部耐药模式，并避免过度使用广谱制剂。在这项研究中，我们分析了如何将胆汁和血液培养的结果以及患者数据用于选择急性胆碱的经验性抗生素治疗。从348例连续的急性胆管炎患者中获得了423例阳性胆管培养物和197例相应的血液培养物，确定了病原体频率和敏感性。从病历中检索患者数据。使用Chi-2检验和多元二元Logistic回归评估患者和微生物学数据之间的关联。在胆汁文化中 肠杆菌和肠球菌的分离频率约为30％，而在血液培养中，肠杆菌占主导（56％，而肠球菌为21％）。肠球菌对氟喹诺酮类，头孢菌素类和酰基脲类青霉素类抗生素的耐药率> 20％，而对碳青霉烯类抗生素的耐药率> 2％。经验疗法的疗效较差，细菌胆汁和血液培养分离株的覆盖率分别为51％和69％。通过多变量分析，确定了病原体种类，抗生素敏感性和预期抗生素覆盖率的预测因子。在大型三级相对中心的未选患者中接受急性胆管炎治疗，似乎需要使用碳青霉烯类药物才能达到较高的抗生素覆盖率。但是，通过分析患者和微生物数据，可以定义高效碳青霉烯保留疗法的亚组。对于不需要重症监护而无胆管假体的社区获得性胆管炎患者，哌拉西林/他唑巴坦代表了一种预期具有良好抗生素覆盖率的方案。