International Journal of Medical Science and Clinical Research Studies ISSN(print): 2767-8326, ISSN(online): 2767-8342 Volume 04 Issue 11 November 2024 Page No: 2026-2031 DOI: https://doi.org/10.47191/ijmscrs/v4-i11-27 , Impact Factor: 7.949 2026 Volume 04 Issue 11 November 2024 Corresponding Author: Carlos de Jesús Hernández López Microbiology of Acute Cholangitis and Cholecystitis and Antimicrobial Susceptibility Carlos de Jesús Hernández López 1 , Oscar Blancarte Vidal 1 , Melissa Alejandra Maciel Parra 3 , Luis Eduardo Cisneros Manríquez 4 , Otoniel Rodríguez Garcia 5 , Rolando González Rosas 6 , Indira García Guevara 7 1,2,3,4,5,6,7 General Surgery, ISSSTE Puebla Regional Hospital, Puebla, 72550, MEX 1 https://orcid.org/0000-0001-7166-7433 2 https://orcid.org/0009-0007-2374-8299 3 https://orcid.org/0009-0008-6298-5104 4 https://orcid.org/0009-0008-2467-7370 5 https://orcid.org/0009-0006-9575-4797 6 https://orcid.org/0000-0002-5974-7016 7 https://orcid.org/0000-0002-5405-929X INTRODUCTION Acute cholangitis and cholecystitis are fatal if not appropriately treated in a timely manner. The Tokyo Guidelines 2018 [1] reported the first large-scale study of patients with acute cholangitis. The mortality rates were 2.4%, 4.7%, and 8.4% by severity grades I, II, and III, respectively, and the incidence of complications was 2.0% and 0.26%, respectively). Bile is normally sterile, but in the presence of obstruction, the risk of cholangitis increases. The most common organisms isolated from bile are Escherichia coli, Klebsiella spp., Enterococcus spp., Streptococcus spp., Enterobacter spp., and Pseudomonas spp. The microbiological characteristics of cholangitis have not changed significantly; however, the emergence of drug resistance among these organisms is a matter of concern [2– 8]. The primary goal of antimicrobial therapy is to limit both systemic septic response and local inflammation. Drainage of obstructed biliary trees ( source control) has been recognized as the mainstay of therapy for patients with acute cholangitis. The role of antimicrobial therapy in acute cholangitis is to allow patients to undergo elective drainage procedures in addition to emergencies. In the TG 18 guidelines, empiric ABSTRACT ARTICLE DETAILS Background: Acute cholecystitis and cholangitis are life-threatening if not treated promptly. Empiric antibiotic therapy is crucial, relying on local studies of bile culture for guidance. Objective: To identify the microbiological and antibiotic susceptibilities of organisms in bile cultures of patients with acute cholangitis and cholecystitis. Materials and Methods: Adults diagnosed with acute cholangitis and/or cholecystitis at the Hospital Regional ISSSTE Puebla (2022-2023) underwent bile aspiration via laparoscopy or open surgery. Microorganisms were isolated from bile cultures and antibiograms were obtained. Patients were classified according to severity according to the Tokyo Guidelines 2018. Results: A total of 88 patients with bile cultures for cholangitis/cholecystitis were included. Fourteen percent of cultures showed no bacterial growth, and E. coli was the most common pathogen with significant antibiotic resistance. Multivariate analysis identified recent antimicrobial therapy (p <0.03), concomitant malignancy (p <0.001), and age >65 years (p <0.0001) as factors associated with resistant bacteria. Thirty-day mortality was 2.3%. Conclusions: Empirical antimicrobial therapy based on TG 2018 was effective across all severity grades. KEYWORDS: Acute Cholangitis, Acute Cholecystitis, Antimicrobial drug resistance, cholangitis. Published On: 20 November 2024 Available on: https://ijmscr.org/