Rapid Communication
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. May 28, 2008; 14(20): 3174-3178
Published online May 28, 2008. doi: 10.3748/wjg.14.3174
In vitro activity of moxifloxacin and piperacillin/sulbactam against pathogens of acute cholangitis
Andreas Weber, Wolfgang Huber, Klaus Kamereck, Philipp Winkle, Petra Voland, Hans Weidenbach, Roland M Schmid, Christian Prinz
Andreas Weber, Wolfgang Huber, Philipp Winkle, Petra Voland, Hans Weidenbach, Roland M Schmid, Christian Prinz, Department of Gastroenterology, Klinikum rechts der Isar, Technical University Munich, Munich 81675, Germany
Klaus Kamereck, Institute of Medical Microbiology, Immunology and Hygiene, Klinikum rechts der Isar, Technical University Munich, Munich 81675, Germany
Author contributions: Weber A and Huber W contributed equally to this work; Weber A, Huber W, Schmid RM and Prinz C designed research; Weber A, Huber W, Weidenbach H, Winkle P and Voland P performed research; Weber A, Huber W, Kamereck K analyzed data; Weber A, Huber W, Schmid RM and Prinz C wrote the paper.
Correspondence to: Dr. Christian Prinz, Professor, Department of Gastroenterology, Klinikum Rechts der Isar, Technical University Munich, Munich 81675, Germany. christian.prinz@lrs.tum.de
Telephone: +49-89-41405973
Fax: +49-89-41407366
Received: January 10, 2008
Revised: March 31, 2008
Accepted: April 7, 2008
Published online: May 28, 2008
Abstract

AIM: To analyze the in vitro activity of moxifloxacin and piperacillin/sulbactam against pathogens isolated from patients with acute cholangitis.

METHODS: In this prospective study a total of 65 patients with acute cholangitis due to biliary stone obstruction (n = 7), benign biliary stricture (n = 16), and malignant biliary stricture (n = 42) were investigated with regard to spectrum of bacterial infection and antibiotic resistance. Pathogens were isolated from bile cultures in all study patients. In 22 febrile patients, blood cultures were also obtained. In vitro activity of moxifloxacin and piperacillin/sulbactam was determined by agar diffusion.

RESULTS: Thirty-one out of 65 patients had positive bile and/or blood cultures. In 31 patients, 63 isolates with 17 different species were identified. The predominant strains were Enterococcus species (26/63), E.coli (13/63) and Klebsiella species (8/63). A comparable in vitro activity of moxifloxacin and piperacillin/sulbactam was observed for E.coli and Klebsiella species. In contrast, Enterococcus species had higher resistances towards moxifloxacin. Overall bacteria showed antibiotic resistances in vitro of 34.9% for piperacillin/sulbactam and 36.5% for moxifloxacin.

CONCLUSION: Enterococcus species, E.coli and Klebsiella species were the most common bacteria isolated from bile and/or blood from patients with acute cholangitis. Overall, a mixed infection with several species was observed, and bacteria showed a comparable in vitro activity for piperacillin/sulbactam and moxifloxacin.

Keywords: Cholangitis, Acute cholangitis, Endoscopy, Antibiotics, Moxifloxacin, Piperacillin, Sulbactam, Biliary stricture, Resistance, Bacterial pathogens