Characteristics, aetiology, antimicrobial resistance and outcomes of bacteraemic cholangitis in patients with solid tumours: A prospective cohort study.
To asses the clinical features, aetiology, antimicrobial resistance and outcomes of bacteraemic cholangitis in patients with solid tumours (ST).



All consecutive episodes of bacteraemia in hospitalized patients were prospectively analysed (2006-2015).



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.



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.
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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Royo-Cebrecos
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. Electronic address: cgudiol@iconcologia.net.
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Gudiol
Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain.
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García
Department of Microbiology, Hospital Universitari de Bellvitge, IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain.
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Tubau
Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain.
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Laporte
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.
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Ardanuy
Department of Oncology, Institut Català d'Oncologia, l'Hospitalet, University of Barcelona, Barcelona, Spain.
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Antonio
Department of Oncology, Institut Català d'Oncologia, l'Hospitalet, University of Barcelona, Barcelona, Spain.
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Marin
Endoscopy Unit, Digestive Disease Department, Hospital Universitari de Bellvitge, IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain.
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Gornals
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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Carratalà
D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000401:mortality; D002761:Cholangitis / Q000209:etiology* / Q000382:microbiology / Q000401:mortality; D015331:Cohort Studies; D024901:Drug Resistance, Multiple, Bacterial; D016984:Enterococcus faecium / Q000302:isolation & purification; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents
Bacteraemia; Bacteremic cholangitis; Biliopancreatic diseases; Bloodstream infection; Cancer; Cholangitis; Solid neoplasm; Solid tumour