Prophylactic Antibiotics for Prevention of Cholangitis in Patients With Biliary Atresia Status Post-Kasai Portoenterostomy

Decharun, Katawaetee; Leys, Charles M.; West, Karen W.; Finnell, S. Maria E.

doi:10.1177/0009922815594760

Cited by 53 publications

(35 citation statements)

References 43 publications

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“…4,[26][27][28] Despite overall improvements in outcomes, the incidence of cholangitis has changed little over time. [29][30][31][32][33][34][35][36] More than 50% of patients (reported to occur between 40 and 93%, this large difference being probably also the result of different diagnostic criteria) after HPE might present one or more episodes of cholangitis 10,37 ; 31% of patients in our series experienced at least one episode of early perioperative cholangitis. Of note, postoperative care changed during the study period (no steroids since 2011), yet incidence of cholangitis did not change over time.…”

Section: Cholangitismentioning

confidence: 99%

Perioperative Complications after Kasai Hepatoportoenterostomy: Data from the Swiss National Biliary Atresia Registry

Calinescu¹,

Wilde²,

Korff

et al. 2019

Eur J Pediatr Surg

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Introduction Hepatoportoenterostomy (HPE) is the first-line treatment for biliary atresia (BA) patients. This study aims to describe perioperative complications after HPE and to analyze their impact on outcome. Materials and Methods Patients with HPE (Swiss National Biliary Atresia Registry, 1994–2017) were retrospectively analyzed. Perioperative complications were defined as complications occurring up to 30 days after surgery. Surgical complications were defined as directly related to the surgical act; medical complications were defined as any other deviation from the uneventful postoperative course. Results Sixty-two patients were included. Median age at HPE was 63 days (18–126). Twenty six patients out of 62 (42%) had ≥ 1 complications: 6/62 (10%) surgical, 24/62 (39%) medical, that is, we observed 7 surgical and 28 medical complications. As for medical complications, cholangitis was the most frequent: 19/28 (68%). Lower gestational age at birth correlated with more overall complications (p = 0.02). Age, weight at HPE, syndromic BA, and postoperative steroid administration were not significantly correlated. There were no perioperative deaths. Perioperative complications did not correlate with overall survival (p = 0.14) and survival with native liver (p = 0.55). Conclusion HPE is often associated with perioperative medical complications. Lower gestational age at birth was significantly associated with more complications. Perioperative complications had no impact on overall outcome.

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Section: Cholangitismentioning

confidence: 99%

Perioperative Complications after Kasai Hepatoportoenterostomy: Data from the Swiss National Biliary Atresia Registry

Calinescu¹,

Wilde²,

Korff

et al. 2019

Eur J Pediatr Surg

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“…16,21,22 Nevertheless, recent trials and systematic reviews have yielded inconclusive results for determining the effectiveness of prophylactic antibiotics for the prevention of cholangitis after the Kasai portoenterostomy. 19,[22][23][24] In addition, there is no strong evidence that the prolonged use of oral prophylactic antibiotics beyond the early postoperative period offers any greater protection against cholangitis. 5,19,23 Still, most experienced institutions provide oral prophylactic antibiotics for periods of 6 months or longer, similar to the requirements of our hospital's protocol.…”

Section: Discussionmentioning

confidence: 99%

“…19,[22][23][24] In addition, there is no strong evidence that the prolonged use of oral prophylactic antibiotics beyond the early postoperative period offers any greater protection against cholangitis. 5,19,23 Still, most experienced institutions provide oral prophylactic antibiotics for periods of 6 months or longer, similar to the requirements of our hospital's protocol. A randomized control trial by Bu et al 22 found that there was a significantly lower rate of recurrent cholangitis among patients provided with prophylactic antibiotics than that for a historical control group who did not receive antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Factors Related to the Clinical Outcomes of the Kasai Procedure in Infants with Biliary Atresia

Tantemsapya

2020

SMJ

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Objective: The Kasai portoenterostomy has been accepted as the primary therapeutic treatment for biliary atresia. However, successful bile drainage does not always promise a long-term native liver survival. Several clinical factors were evaluated to discover associations with the outcomes. Methods: A retrospective chart review was conducted of infants with biliary atresia who underwent the conventional Kasai portoenterostomy at Siriraj Hospital, January 2006-August 2018. The patient demographics, perioperative clinical and laboratory data, adjuvant therapies, complications, and interventions were analyzed in correlation to the short-and long-term outcomes. The short-term outcome evaluated was the resolution of jaundice, while the long-term outcome was remaining jaundice-free with the native liver. Results: The complete medical records of 80 patients were retrospectively reviewed. Their mean age at the time of the Kasai portoenterostomies was 97 days. Overall, 66.3% achieved jaundice clearance. The mean follow-up duration was 50.5 months, with 51.3% of the patients remaining jaundice-free with their native liver. A prolonged duration of a prophylactic antibiotic was significantly related to the jaundice clearance, with a p-value of 0.002. Moreover, a lower number of episodes of cholangitis was significantly related to a good long-term outcome (p-value, 0.024). Conclusion: The prolonged provision of a prophylactic antibiotic as adjuvant therapy after the Kasai portoenterostomy was associated with jaundice clearance. An increased incidence of cholangitis episodes was associated with poor long-term outcomes. Postoperative adjuvant therapy should be standardized and maintained for the care of biliary atresia patients to improve their outcomes.

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“…Cholangitis is the most common complication in BA patients after KPE, the incidence is about 50%~90%. It has reported that varies regimes for prevention of cholangitis in patients with BA after KPE, prophylactic antibiotics after KPE to reduce the incidence of cholangitis is universal, but few published studies provide satisfactory evidence for its benefit [11] . furthermore, the latest research, Wen Bo Pang et al reported that prophylactic imipenem-cilastatin and human immunoglobulin is effectively on the prevention of early-onset cholangitis (12).…”

Section: Discussionmentioning

confidence: 99%

Intravenous antibiotics for the treatments of cholangitis after Kasai operation in biliary atresia patients

Wang¹,

Li²,

Jiao³

et al. 2020

Preprint

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Objective: This is a single-center, retrospective study, to assess the experimental treatment of intravenous antibiotics for cholangitis after Kasai portoenterostomy (PKE) in biliary atresia (BA) patients.Methods: 153 cholangitis patients after PKE from January 2016 to December 2018 were retrospectively reviewed. Based on the different kinds of antibiotics treatment, all patients were divided into 3 groups: Intravenous Cefoperazone Sodium Tazobactam Sodium (ICSTS) group, Intravenous Meropenem (IMP) group, Meropenem combined with Intravenous immunoglobulin (IVIG) group, compared the tre atment effect among 3 groups.Results: The recurrent cholangitis rate of ICSTS group, IMP group and IVIG group is 28.9%,39.4%, 85.7% respectively. The IVIG group had higher temperature (T), white blood cell (WBC), C-reactive protein (CRP), alanine transaminase (ALT) and aspartate transaminase (AST) lever than ICSTS group and IMP group (P <0.05) before interference. The antifebrile rate had no significant difference among 3 groups after 3 days hospitalization, as we expected, the level of WBC, CRP, DBL was significant descend in each group, the level of ALT, AST, γ-GGT was obviously decline in IVIG group. After 3 months followed-up, IVIG group showed a recurrent rate of 82%, which was higher than ICSTS group and IMP group (P=0.013), the cholangitis frequency was significant higher in IVIG group than ICSTS group and IMP group (P<0.05).Conclusions: Personalized intravenous antibiotics to treat cholangitis considering recurrent episode, the severity of infection and liver function, may be a more appropriate treatment strategy.

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Prophylactic Antibiotics for Prevention of Cholangitis in Patients With Biliary Atresia Status Post-Kasai Portoenterostomy

Abstract: Few published studies measure the effect of prophylactic antibiotics after Kasai portoenterostomy. We identified 4 studies and they presented contradictory results. Prospective research is needed.

Cited by 53 publications

References 43 publications

Perioperative Complications after Kasai Hepatoportoenterostomy: Data from the Swiss National Biliary Atresia Registry

Perioperative Complications after Kasai Hepatoportoenterostomy: Data from the Swiss National Biliary Atresia Registry

Factors Related to the Clinical Outcomes of the Kasai Procedure in Infants with Biliary Atresia

Intravenous antibiotics for the treatments of cholangitis after Kasai operation in biliary atresia patients

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