Increasing burden of biliary tract infection caused by extended‐spectrum beta‐lactamase‐producing organisms in Korea: A nationwide population‐based study. Issue 1 (13th August 2019)

• Record Type: Journal Article
• Authors: Jang, Dong Kee; Kim, Jungmee; Park, Wan Beom; Yi, Sun Young; Lee, Jun Kyu; Yoon, Won Jae
• Is Part Of: Journal of gastroenterology and hepatology. Volume 35:Issue 1(2020)
• Page Start: 56
• Page End: 64
• Publication Date: 2019-08-13
• Subjects: biliary tract diseases -- cholangitis -- cholecystitis -- extended‐spectrum beta‐lactamase; Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Gastroenterology -- Periodicals; Liver Diseases -- Periodicals; 616.33
• DOI: 10.1111/jgh.14809
• Languages: English
• ISSNs: 0815-9319

Abstract

Abstract: Background and Aim: Biliary tract infections (BTIs) are a major cause of bacteremia. The prevalence of antibiotic‐resistant pathogens in BTI patients is reported to be increasing. We used a nationwide database to evaluate the prevalence of, and risk factors for, BTIs caused by extended‐spectrum beta‐lactamase‐producing organisms (ESBL‐PO) in Korea. Methods: Patients with a BTI diagnosis, an admission history, a history of a BTI‐related procedure, and antibiotic use for ≥ 4 days between 2007 and 2016 were identified from the Health Insurance Review and Assessment Service database. A BTI treated with carbapenems (BTI‐TC) was used as the surrogate for a BTI caused by ESBL‐PO. We conducted a multivariate logistic regression analysis to determine the risk factors for BTI‐TC. Results: In total, 341 002 patients were enrolled. The overall percentage of BTI‐TC among BTIs was 2.4%, with an increasing annual trend ( P < 0.0001). The risk of acute cholangitis caused by ESBL‐PO increased significantly in men, older patients, patients with comorbidities, patients with a history of a biliary procedure within the previous year, and patients with a history of antibiotic use within the previous 90 days. Regarding antibiotic use, the patients at highest risk were those previously prescribed carbapenems (adjusted odds ratio, 4.77; P < 0.0001). Conclusions: The prevalence of BTIs caused by ESBL‐PO has increased during the last 10 years. Initial carbapenem therapy should be considered for elderly patients with acute cholangitis if they have had a previous biliary procedure and/or a history of carbapenem administration within the previous 90 days.