Diagnostic microbiology and infectious disease · 2026
Risk factors and predictors for mixed Gram-negative and Gram-positive bacterial infection in acute cholangitis.
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Tian Shijing, Liu Chang, Xu Yuanyuan, Zhou Fachun
Аннотация
BACKGROUND: Our prior studies revealed that mixed Gram-negative and Gram-positive bacterial infections in acute cholangitis are more severe and have higher mortality rates. This study aims to identify the risk factors and predictors for such infections in acute cholangitis.
METHODS: A retrospective review of patients meeting selection criteria based on blood and bile culture results for different pathogenic bacteria was conducted, with comprehensive clinical and laboratory data analyzed.
RESULTS: A total of 503 patients were enrolled. Mixed bacterial growth developed in 134 patients (26.6%) while non-mixed bacterial growth developed in 369 patients (73.4%). Mixed bacterial infection was identified as an independent risk factor for in-hospital death ((odds ratio (OR), 5.23 [95% confidence interval (CI) 1.55-17.60], p=0.008). Cardiovascular disease (OR 1.75 [95% CI 1.12-2.73], p=0.015), chronic renal insufficiency (OR 4.68 [95% CI 1.07-20.46], p=0.040), biliary stent placement (OR 3.12 [95% CI 1.54-6.42], p=0.002), surgical incision and drainage history (OR 1.98 [95% CI 1.12-3.49], p=0.019), and biliary anastomosis(OR 9.53 [95% CI 1.83-49.76], p=0.007) were independently associated with mixed bacterial infection in multivariate analysis. The ROC (receiver operating characteristic) curves for subjects with mixed bacterial infections using Acute Physiology And Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment score (SOFA) were 0.721 (95% CI, 0.67-0.77, P<0.001) and 0.718 (95% CI, 0.67-0.77, P<0.001), respectively.
CONCLUSIONS: In acute cholangitis, cardiovascular disease, chronic renal insufficiency, surgical incision and drainage history, biliary stent placement and biliary anastomosis were independent risk factors for mixed bacterial infection.
METHODS: A retrospective review of patients meeting selection criteria based on blood and bile culture results for different pathogenic bacteria was conducted, with comprehensive clinical and laboratory data analyzed.
RESULTS: A total of 503 patients were enrolled. Mixed bacterial growth developed in 134 patients (26.6%) while non-mixed bacterial growth developed in 369 patients (73.4%). Mixed bacterial infection was identified as an independent risk factor for in-hospital death ((odds ratio (OR), 5.23 [95% confidence interval (CI) 1.55-17.60], p=0.008). Cardiovascular disease (OR 1.75 [95% CI 1.12-2.73], p=0.015), chronic renal insufficiency (OR 4.68 [95% CI 1.07-20.46], p=0.040), biliary stent placement (OR 3.12 [95% CI 1.54-6.42], p=0.002), surgical incision and drainage history (OR 1.98 [95% CI 1.12-3.49], p=0.019), and biliary anastomosis(OR 9.53 [95% CI 1.83-49.76], p=0.007) were independently associated with mixed bacterial infection in multivariate analysis. The ROC (receiver operating characteristic) curves for subjects with mixed bacterial infections using Acute Physiology And Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment score (SOFA) were 0.721 (95% CI, 0.67-0.77, P<0.001) and 0.718 (95% CI, 0.67-0.77, P<0.001), respectively.
CONCLUSIONS: In acute cholangitis, cardiovascular disease, chronic renal insufficiency, surgical incision and drainage history, biliary stent placement and biliary anastomosis were independent risk factors for mixed bacterial infection.