P0840 Could the ‘old’ antibiotic temocillin be a ‘new’ treatment for acute bacterial cholangitis? A retrospective study of 156 cases Sylvain Chawki1, Marion Duprilot1, Gary Taieb1, Veronique Leflon1, Marie-Hélène Nicolas-Chanoine1, Bruno Fantin1, Victoire De Lastours*1

1 Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France Background: Acute cholangitis is a potentially severe infection requiring rapid active antimicrobial therapy. Thus, emergence of multidrug resistant strains of Enterobacteriaceae is a rising global public-health issue. To spare carbapenems, alternative therapies are needed. Temocillin is a narrow-spectrum betalactam targeting almost specifically Enterobacteriaceae, including most isolates resistant to third generation cephalosporin (3GC) and some carbapenemase-producers. Temocillin biliary concentrations may reach several times the blood concentrations. We assessed whether temocillin may represent an alternative treatment for bacterial cholangitis. Materials/methods: In this retrospective monocentric study, all patients from November 2015 to December 2017 admitted for acute cholangitis with a positive culture (blood or bile) were included. Demographic characteristics, severity, treatment and outcome of each episode were collected. Susceptibility to antibiotics, including temocillin, was determined phenotypically. Episodes of cholangitis were considered susceptible to temocillin if all pathogens found were temocillin-susceptible. Results: 137 patients (77/137 male; 56%; median age 67 [60-75]) who suffered 156 episodes of bacterial cholangitis were included (19 patients had 2 separate episodes during the study period). The median Charlson score was 4 [2-8]; 66/137 (48%) were immunocompromised, 54/137 (39%) had a history episode of acute cholangitis. 118/156 (75.6%) episodes were healthcare-associated, 28/156 (18%) required intensive care and 12 (7.7%) were fatal. The main cause of cholangitis was cancer-related obstruction (79/156; 50.6%) followed by lithiasis (29;18.6%). 71/156 (45.5%) episodes were polymicrobial, including 45 in which only Enterobacteriaceae were evidenced. Among the 223 Enterobacteriaceae isolated, 20 (9%), 33 (14.8%) and 53 (24%) were resistant to temocillin, piperacilline/tazobactam and 3GC, respectively. However, full cholangitis episodes were resistant to temocillin, piperacillin/tazobactam and 3GC in 65/156 (41.6%), 41 (26.2%) and 59 (37.8%) cases, respectively. All community-acquired episodes were temocillin-susceptible. The main reason for temocillin non-susceptible episodes was the presence of Gram positive or anaerobic bacteria (46/65; 70.7%). Conclusions: Temocillin may constitute an interesting alternative to treat bacterial cholangitis after microbiological documentation or as empirical therapy in community-acquired episodes; however, in healthcare- associated infections, because of its narrow spectrum and the high prevalence of polymicrobial infections, temocillin does not constitute an empirical therapeutic option.

29TH ECCMID 13-16 APRIL 2019 AMSTERDAM, NETHERLANDS POWERED BY M-ANAGE.COM