Updated comprehensive epidemiology, microbiology, and outcomes among patients with acute cholangitis

Abstract

Background The international practice guidelines for patients with acute cholangitis and cholecystitis were released in 2007 (TG07) and revised in 2013 (TG13). This study investigated updated epidemiology and outcomes among patients with acute cholangitis on a larger scale for the first time. Methods This is an international multi-center retrospective observational study in Japan and Taiwan. All consecutive patients older than 18 years of age and given a clinical diagnosis of acute cholangitis by clinicians between 1 January 2011 and 31 December 2012 were enrolled. Those who met the diagnostic criteria of acute cholangitis by TG13 were statistically analyzed. Results A total of 7,294 patients were enrolled and 6,433 patients met the TG13 diagnostic criteria. The severity distribution was Grade I (37.5%), Grade II (36.2%), and Grade III (26.2%). The 30-day all-cause mortality was 2.4%, 4.7%, and 8.4% in Grade I, II, III severity, respectively (P < 0.001). The incidence of liver abscess and endocarditis as complications of acute cholangitis was 2.0% and 0.26%, respectively. Conclusions This is the first large scale study to investigate patients with acute cholangitis. This study provides the basis to define the best practices to manage patients with acute cholangitis in future studies.

Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis

“…See the paper by Miura et al for more details on initial treatment . The approaches specified in papers by Gomi et al regarding the choice of antimicrobial and optimum treatment duration or blood/bile culture should be reviewed and implemented; these papers also provide an understanding of the specific characteristics of bile duct infections . Refer to Gomi et al on TG18 for the specific names of antimicrobials and other details .…”

Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis

“…In previous guidelines (TG13), we defined a severity grading system. A recent large‐scale study indicated the mortality rate (30‐day all‐cause mortality rate) of 2.4%, 4.7%, 8.4% by TG13 severity grade I, II, and III, respectively . For patients with septic shock, appropriate antimicrobial therapy should be administered within an hour .…”

“…The bacteria commonly found in biliary tract infections are well known, and are presented in Tables and . A large‐scale multicenter international observational study was conducted and published in 2017 on epidemiology and microbiology among patients with acute cholangitis .…”

“…Data from Rhodes et al was integrated for the Tokyo Guidelines 2018 (TG18). The data are from references …”

“… Table is cited from the Tokyo Guidelines 2013 (TG13) . Data from Gomi et al was integrated for the Tokyo Guidelines 2018 (TG18) …”