The Importance of Early Management of Severe Biliary Infection: Current Concepts

Abstract

Background. The incidence of biliary infections is rising worldwide and has become one of the main reasons for emergency admissions. Methods. Narrative review of the literature emphasizing news concepts related to the early management of biliary diseases. Results. The bacteriology is frequently polymicrobial, with a progressive increase of multidrug resistant bacteria. The form of presentation is variable, and the mortality rate may reach 20%. When cholecystitis or cholangitis is suspected, ultrasound is the gold standard imaging test. Depending on the severity of presentation, local resistances and risk factors for multi-resistant organisms, the most appropriate empirical antibiotic treatment must be initiated. In acute cholecystitis, cholecystectomy plays the main therapeutic role. In patients not suitable for surgery, percutaneous cholecystostomy is a valid alternative for source control. Treatment of severe cholangitis is based on the drainage of the bile duct and antibiotic therapy. Conclusions. Biliary infections are serious conditions which can lead to sepsis and death. The introduction of new internationally accepted guidelines, based on clinical presentation, laboratory tests and imaging, provides a platform for their timely diagnosis and management. Early severity assessment, initiation of intravenous antibiotics and source control are fundamental to improving morbidity and mortality.

Early Management of Severe Biliary Infection in the Era of the Tokyo Guidelines

“…Summary of suggested empirical antibiotic treatment of biliary infection. Modified from Amillo-Zaragüeta et al[82]. According to the criteria in Table4.…”

“…Main novelties in the management of biliary infection over the last decade. Modified from Amillo-Zaragüeta et al[82].Increasingisolation of Enterococcus spp., Enterococcus faecium, and Pseudomonas in acute cholangitis. Increased resistance of E. coli and Klebsiella spp.…”