Microbiology and clinical characteristics of acute cholangitis with their impact on mortality; A retrospective cross-sectional study.

Akhtar, Furqana; Siddique, Muhammad Zeeshan; Raza, Aun; Mehmood, Shafqat; Yusuf, Muhammad; Sultan, Faisal

doi:10.5455/jpma.29747

Cited by 5 publications

(1 citation statement)

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“…In our study, the mixed Gram-negative and Gram-positive bacteria culture rate was 35.1%, second only to Gram-negative, accounting for 49.5%, which was consistent with other studies [ 22 ]. Some studies even found that the proportion of mixed infections was higher than that of monomicrobial infections [ 23 ].…”

Section: Discussionsupporting

confidence: 93%

Clinical characteristics of Gram-negative and Gram-positive bacterial infection in acute cholangitis: a retrospective observational study

Tian

Tang

et al. 2022

BMC Infect Dis

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Background To investigate the difference in the severity of illness, organ dysfunction, and prognosis of acute cholangitis due to different pathogenic bacterial infection types. Methods A retrospective observational study was performed. Patients who met the selection criteria according to blood culture and bile culture results of different pathogenic bacterial were divided into groups. The severity of illness, organ dysfunction, and prognosis of the groups were analyzed and compared comprehensively. Results A total of 424 patients were included, and no bacterial growth developed in 111 patients (26.2%). Among the 313 patients (73.8%) with bacterial growth, 155 patients had only Gram-negative bacteria cultured (49.5%), 48 patients had only Gram-positive bacteria cultured (15.3%), and 110 patients had both Gram-negative and Gram-positive bacteria cultured (35.1%). The proportion of Grade III patients and the APACHE II and SOFA scores of the mixed Gram-negative and positive group were the highest (p < 0.05); the intensive care unit admission day and hospital stay were longer, and the mortality rate were also higher 20/110 (18.2%) than the other two groups. Regression analysis showed that bacterial growth was an independent risk factor for organ dysfunction. The risks of an increased septic shock, neurological dysfunction, hepatic dysfunction, hematological dysfunction, and respiratory dysfunction in the mixed Gram-negative and positive group were higher than the Gram-negative group (P < 0.05). The Cox proportional hazards regression prompt showed that different culture results were independent risk factors for death. The mixed Gram-negative and positive group had increased hazard ratios and 95% CI of 7.30 (95% CI 1.55 to 34.38) compared with the Gram-negative group. There was no difference between the Gram-negative group and the Gram-positive group in the severity of illness, organ dysfunction, intensive care unit admission day, hospital stay, mortality rate, and risk of death (P > 0.05). Conclusions In acute cholangitis, mixed infection with Gram-negative and Gram-positive bacteria was more severe and was associated with a higher risk of death. There were no apparent differences between Gram-negative and Gram-positive bacterial infections.

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Section: Discussionsupporting

confidence: 93%

Clinical characteristics of Gram-negative and Gram-positive bacterial infection in acute cholangitis: a retrospective observational study

Tian

Tang

et al. 2022

BMC Infect Dis

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Neutrophil-lymphocyte Ratio Predicts Clinical Response to Percutaneous Transhepatic Biliary Drainage in Acute Cholangitis

Kaur

Chandel

Reddy

et al. 2023

Journal of Clinical and Experimental Hepatology

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Diagnosis and Treatment of Acute Cholangitis

Lee¹

2022

Korean J Pancreas Biliary Tract

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Acute cholangitis is a clinical syndrome characterized by fever, jaundice, and abdominal pain that develops as a result of stasis and infection in the biliary tract. It can be a life-threatening condition if it is not recognized early. Patients with severe cholangitis may present with hypotension, and mental status changes. The most frequent causes of acute cholangitis are biliary calculi, benign biliary stricture, and malignancy. The most common pathogens isolated are gram-negative bacteria (Escherichia coli, followed by Klebsiella species and Enterobacter species). A diagnosis of acute cholangitis requires evidence of systemic inflammation, cholestasis, and imaging with biliary obstruction. Imaging studies may consist of ultrasound, computed tomography, magnetic resonance cholangiopancreatography, and/or endoscopic ultrasound. The mainstay of treatment consists of fluid resuscitation, antibiotics, and biliary drainage. Penicillin/β-lactamase, third-generation cephalosporin, or carbapenem are all acceptable choices for first-line treatment. In patients with severe cholangitis, biliary drainage should be performed within 24 hours. Patients with severe acute cholangitis require urgent (within 24 hours) biliary decompression. Endoscopic retrograde cholangiopancreatography remains the preferred modality for biliary drainage. In conclusion, acute cholangitis is mostly treatable when recognized and treated early. Recognizing and initiating early treatment leads to markedly decreased patient morbidity and mortality.

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Microbiology and clinical characteristics of acute cholangitis with their impact on mortality; A retrospective cross-sectional study.

Cited by 5 publications

References 0 publications

Clinical characteristics of Gram-negative and Gram-positive bacterial infection in acute cholangitis: a retrospective observational study

Clinical characteristics of Gram-negative and Gram-positive bacterial infection in acute cholangitis: a retrospective observational study

Neutrophil-lymphocyte Ratio Predicts Clinical Response to Percutaneous Transhepatic Biliary Drainage in Acute Cholangitis

Diagnosis and Treatment of Acute Cholangitis

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