{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T20:39:01Z","timestamp":1773779941627,"version":"3.50.1"},"reference-count":19,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute cholangitis, a severe biliary infection that is frequently caused by gram-negative pathogens, presents health challenges owing to the increasing prevalence of antimicrobial resistance, particularly among extended-spectrum beta\u2013lactamase (ESBL)-producing bacteria. Accurate risk stratification of patients with extended-spectrum beta-lactamase\u2013producing bacteria is crucial for optimizing antimicrobial therapies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study aimed to develop and internally validate a risk stratification scoring system for identifying ESBL-producing bacteria in patients with acute cholangitis, with the goal of supporting clinical risk stratification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort analysis included adult patients with acute cholangitis admitted between 2019 and 2023. Patients were excluded if they had incomplete medical records, missing microbiological data, or non-adherence to the Tokyo Guidelines 2018 diagnostic criteria. Predictors of positivity for ESBL-producing bacteria were identified using multivariate logistic regression and integrated into a scoring system, and the performance metrics were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 303 patients with positive blood or bile cultures were included in the analysis, of whom 111 (36.6%) had ESBL-positive cholangitis. Independent predictors of positivity for ESBL-producing bacteria included prior antibiotic treatment (3.5 points), chills with rigors (2.5 points), alanine aminotransferase levels &lt;400 U\/L (3.5 points), hematocrit levels &lt;27% (2.5 points), and alkaline phosphatase levels &gt;300 U\/L (2.0 point). At cutoff scores of 7.5 and 11, the scoring system demonstrated sensitivity of 56% and 16%, specificity of 75% and 98%, positive predictive values of 56% and 82%, and overall accuracy of 68% and 70%, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This preliminary scoring system demonstrated high specificity at higher cutoffs, supporting its use as a rule-in tool for identifying patients at high risk of ESBL-producing bacteria in acute cholangitis. However, its moderate sensitivity limits its role as a rule-out strategy. This preliminary internally validated model should not be used to guide routine clinical decision-making without external multicenter validation, and any application must consider local resistance patterns and patient context.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0345150","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T17:24:01Z","timestamp":1773768241000},"page":"e0345150","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and internal validation of a risk stratification scoring system for identifying gram-negative ESBL-positive acute cholangitis: A retrospective cohort study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6992-033X","authenticated-orcid":true,"given":"Phoomjai","family":"Sornsenee","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chanchanok","family":"Chaochuensuk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Duangkiat","family":"Sapsong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kanyakorn","family":"Khongchuy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Panitsara","family":"Raksorn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paisit","family":"Kangton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phirada","family":"Khongrueang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suppachai","family":"Choengdee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suphajit","family":"Nuypud","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teerapob","family":"Wetchasit","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thanet","family":"Oonthae","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanawat","family":"Pattarapuntakul","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nisa","family":"Netinatsunton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaksin","family":"Sottisuporn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2868-841X","authenticated-orcid":true,"given":"Thanawin","family":"Wong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"issue":"6","key":"pone.0345150.ref001","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/j.jviscsurg.2019.05.007","article-title":"Acute 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