Acute cholangitis results from a wide spectrum of bacterial pathogens that are present in biliary tree obstructions, and is a common cause of bacteremia. It requires treatments ranging from antibiotics alone to urgent decompression of the biliary system according to disease severity. Although the reported mortality rate in patients with bacteremic cholangitis has been decreasing, it ranges from approximately 10% to 20% despite advances in antimicrobial treatment and drainage of obstructed biliary tracts. The purpose of this study is to identify the clinical factors associated with mortality in bacteremic cholangitis against the background of current medical practice at a Japanese tertiary care center.
We performed a retrospective cohort study of the first episode of cholangitis with bacteremia at a 790-bed, Japanese tertiary care hospital from January, 2009 to December, 2014. Demographic characteristics, and clinical and microbiology data were obtained. Factors associated with 30-day mortality in patients with bacteremic cholangitis were assessed.
We identified 289 patients with bacteremic cholangitis. The median age was 76 (range 28-98), and 170/289 (58.8%) were male. Choledocholithiasis and hepatobiliary malignancy were the most common causes of cholangitis. Endoscopic retrograde cholangiopancreatography was performed for 212 (73.4%) patients. Twenty-two patients (7.6%) died <30 days after the first positive blood culture. Factors associated with a 30-day mortality were Charlson comorbidity index [adjusted odds ratio (aOR) 1.35; 95%CI 1.13-1.61] and septic shock within 48 hours after the first positive blood culture [adjusted odds ratio (aOR) 4.45; 95%CI 1.66-11.93]. Endoscopic retrograde cholangiopancreatography (ERCP) was associated with a reduction in 30-day mortality [adjusted odds ratio (aOR) 0.3; 95%CI 0.11-0.81].
Mortality in patients with bacteremic cholangitis in the context of medical current practice appears to be lower than in previous reports. Decompression of the biliary tract was independently associated with 30-day mortality. Prompt ERCP remains the most important strategy against bacteremic cholangitis.
M. Kakutani, None
R. Chino, None
A. Yoshida, None
H. Honda, None