An Analysis of Infectious Failures in Acute Cholangitis

Jesse Thompson, Robert S. Bennion, Henry A. Pitt

Research output: Contribution to journalArticlepeer-review

Abstract

To determine the factors responsible for therapeutic failures in acute cholangitis, a series of 127 patients was analyzed. There were 64 females and 63 males whose mean age was 57.2 years. Ninetyfour (74.0%) of these patients were clinically cured with initial measures, whereas 33 patients (26%) failed initial therapy for an infectious reason. No differences were observed between the two groups in regard to age and gender. However, more patients in the group that failed had a malignant cause for their bile duct obstruction (72.7% vs. 42.6%, p < 0.01) and had a pretreatment positive blood culture (45.5% vs. 13.8%, p < 0.01). Patients who failed had a higher mean total bilirubin level (9.7 mg/dl vs. 5.5 mg/dl, p < 0.005) and more of them had a level greater than 2.2 mg/dl (97% vs. 69.9%, p < 0.001). Also, more bile cultures were initially positive (93.9% vs. 76.6%, p < 0.05) and more organisms were isolated per culture (3.88 vs. 2.86, p < 0.03) in the patients who failed. In addition, more patients failed who had two or more organisms in the bile (33% vs. 8.3%, p < 0.02). Patients in whom Candida, or any panresistant organism was isolated also tended to fail. Multivariant analysis showed that malignancy, bacteremia, bilirubin > 2.2 mg/dl, > 2 organisms in the bile and a panresistant organism were the best predictors of treatment failure with a serum bilirubin level > 2.2 mg/dl being the variable that increases a patient's log-odds ratio of failure the greatest. In conclusion, patients with acute cholangitis who have an increased chance to fail initial therapy can be identified, and treatment altered accordingly.

Original languageEnglish (US)
Pages (from-to)139-145
Number of pages7
JournalHPB Surgery
Volume8
Issue number2
DOIs
StatePublished - 1994

Keywords

  • Cholangitis
  • biliary antibiotics
  • biliary infection

ASJC Scopus subject areas

  • Surgery
  • Hepatology

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