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Volume 15
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Article

Retrospective Analysis of the Epidemiology and Risk Factors for Recurrent Biliary-Source Bloodstream Infections in Oncologic Patients

by
Paola Maffezzoli
1,
Ignacio Grafia
2,3,
Mar Cusó Banús
4,
Aina Gutiérrez-Santos
4,
Alba Fernández
5,
Ana Peris
2,
Laia Llobera
6,
Maria Dolores Quesada
7,
Daniela Buccione
6,
Silvia Corcione
8,9,
Carolina Tudela
6,
Carme Bracke
2,
Anna Esquerrà
6,
Alba Romero
2,
Gabriela Cerdà
6,
Rosa Benítez
2,
Aina Mateu
6,
Anna Sales
6,
Alex Soriano
10,11,
Roger Paredes
2,12,
Pere-Joan Cardona
7,
Francesco Giuseppe De Rosa
1,9,
María Luisa Pedro-Botet
2,12 and
Pedro Puerta-Alcalde
2,12,13,*add Show full author list remove Hide full author list
1
Department of Medical Sciences, Internal Medicine, University of Turin, 10124 Turin, Italy
2
Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
3
Department of Medicine, Universitat de Barcelona (UB), 08036 Barcelona, Spain
4
Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
5
Department of Dermatology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
6
Department of Oncology, Hospital Universitari Germans Trias i Pujol, ICO, 08916 Badalona, Spain
7
Department of Clinical Microbiology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
8
Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
9
Division of Geographic Medicine, Tufts University School of Medicine, Boston, MA 02111, USA
10
Infectious Diseases Department, Hospital Clínic-IDIBAPS, 08036 Barcelona, Spain
11
CIBERINF Ciber in Infectious Diseases, ISCIII, Madrid 28029, Spain
12
Fundació Lluita Contra les Infeccions, 08916 Badalona, Spain
13
Department of Medicine, University of Vic (UVic), 08500 Vic, Spain
 
add Show full affiliation list
 
remove Hide full affiliation list
*
Author to whom correspondence should be addressed.
Antibiotics 2026, 15(4), 342; https://doi.org/10.3390/antibiotics15040342
Submission received: 7 February 2026 / Revised: 24 March 2026 / Accepted: 25 March 2026 / Published: 27 March 2026
(This article belongs to the Special Issue Multidrug-Resistant Gram-Negative Bacteria Infections: Current Epidemiology, Prognosis and Treatment Options)
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Abstract

Background: We aimed to describe the clinical and microbiological characteristics of biliary-source bloodstream infections (bBSIs) in patients with malignancies and identify risk factors for recurrence. Methods: All bBSI episodes in patients with active solid tumors during 2021–2025 were retrospectively reviewed. Independent risk factors for recurrent bBSI and mortality were identified. A previously published recurrence risk score was externally validated. Results: Overall, 136 patients experienced 199 bBSI episodes. Pancreatic (36.7%) and biliary tract (33.2%) were the most common cancers, and 60.8% had metastatic disease. The main pathogens were Escherichia coli (43.2%), Klebsiella pneumoniae (24.1%), and Enterococcus faecium (19.1%), and multidrug-resistant organisms accounted for 19.1%. Inappropriate empirical antibiotic treatment (IEAT) occurred in 37.2% and was independently associated with increased 30-day mortality, together with metastatic disease and septic shock. Thirty-day mortality was 24.6%. Recurrent bBSI occurred in 35.7% and was independently associated with biliary tract cancer, previous multidrug-resistant isolation, and prior hospitalization for suspected biliary infection. The externally validated recurrence score showed excellent discrimination (AUC 0.815). Conclusions: bBSI in oncology patients is associated with high rates of MDR pathogens, IEAT, recurrence, and mortality. A simple clinical score may identify patients at high risk of recurrence and guide preventive strategies.
Keywords: cholangitis; bacteremia; biliary-source bloodstream infection; mortality; empirical treatment cholangitis; bacteremia; biliary-source bloodstream infection; mortality; empirical treatment

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MDPI and ACS Style

Maffezzoli, P.; Grafia, I.; Banús, M.C.; Gutiérrez-Santos, A.; Fernández, A.; Peris, A.; Llobera, L.; Quesada, M.D.; Buccione, D.; Corcione, S.; et al. Retrospective Analysis of the Epidemiology and Risk Factors for Recurrent Biliary-Source Bloodstream Infections in Oncologic Patients. Antibiotics 2026, 15, 342. https://doi.org/10.3390/antibiotics15040342

AMA Style

Maffezzoli P, Grafia I, Banús MC, Gutiérrez-Santos A, Fernández A, Peris A, Llobera L, Quesada MD, Buccione D, Corcione S, et al. Retrospective Analysis of the Epidemiology and Risk Factors for Recurrent Biliary-Source Bloodstream Infections in Oncologic Patients. Antibiotics. 2026; 15(4):342. https://doi.org/10.3390/antibiotics15040342

Chicago/Turabian Style

Maffezzoli, Paola, Ignacio Grafia, Mar Cusó Banús, Aina Gutiérrez-Santos, Alba Fernández, Ana Peris, Laia Llobera, Maria Dolores Quesada, Daniela Buccione, Silvia Corcione, and et al. 2026. "Retrospective Analysis of the Epidemiology and Risk Factors for Recurrent Biliary-Source Bloodstream Infections in Oncologic Patients" Antibiotics 15, no. 4: 342. https://doi.org/10.3390/antibiotics15040342

APA Style

Maffezzoli, P., Grafia, I., Banús, M. C., Gutiérrez-Santos, A., Fernández, A., Peris, A., Llobera, L., Quesada, M. D., Buccione, D., Corcione, S., Tudela, C., Bracke, C., Esquerrà, A., Romero, A., Cerdà, G., Benítez, R., Mateu, A., Sales, A., Soriano, A., ... Puerta-Alcalde, P. (2026). Retrospective Analysis of the Epidemiology and Risk Factors for Recurrent Biliary-Source Bloodstream Infections in Oncologic Patients. Antibiotics, 15(4), 342. https://doi.org/10.3390/antibiotics15040342

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