Septic Acute Cholecystitis

Kuo, Chien-Lin; Changchien, Chi‐Sin; Chen, J J; Tai, Dar‐In; Chiou, Shue-Shian; Lee, C M

doi:10.3109/00365529509093276

Cited by 45 publications

(37 citation statements)

References 21 publications

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“…This is similar to reported rates in prior studies [3][4][5]13]. These patients are often labeled as having bacteremic ascending cholangitis.…”

Section: Discussionsupporting

confidence: 80%

“…Blood cultures obtained before the initiation of antibiotics from patients with biliary infection are positive in only a small proportion of patients [3][4][5]. The growth is often mono-microbial, predominantly gram-negative organisms [3,5,6]; however, bile cultures often have a poly-microbial growth, especially in patients with an indwelling biliary stent [7][8][9].…”

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confidence: 99%

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Endoscopic Retrograde Cholangio-Pancreatography-Obtained Bile Culture Can Guide Antibiotic Therapy in Acute Cholangitis

Chandra

Klair

Soota

et al. 2018

Dig Dis

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Background: Only a small proportion of patients with biliary tree infection grow microorganisms in blood cultures. Antibiotics chosen or tailored based on organisms identified on blood cultures have a potential for under-treatment and unfavorable outcomes, including recurrent infection and early stent occlusion. In our current practice, we collect bile for culture if an Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is performed in patients with suspected cholangitis. In this study, we compare the microbial yield of blood cultures and ERCP-obtained bile cultures in patients with ascending cholangitis. Methods: We reviewed medical records of all the patients treated for ascending cholangitis who had blood cultures and ERCP-obtained bile cultures at a tertiary care center between 2010 and 2016. Bile was collected for culture before injecting contrast, via a catheter after discarding the initial 3 mL. Results: Ninety-three patients were included with mean age of 71 (±15) years. Out of 93 patients, 11 (12%) had prior sphincterotomy, 29 (31%) had an indwelling biliary stent, and malignant obstruction was the most common etiology (34%). ERCP-obtained bile cultures were positive in 90 out of 93 (97%) patients with monomicrobial growth in 34 out of 93 (39%) patients. Mixed intestinal flora was noted in 3 patients. Blood cultures were positive in only 30 out of 93 patients (32%) and 24 out of 93 (26%) patients had monomicrobial growth. Totally 26 out of 30 patients (87%) grew the same organism as the bile culture, 3 grew an organism different from bile cultures, and one had no growth in the bile culture. On multivariable analysis, the presence of an indwelling biliary stent was the lone factor associated with polymicrobial growth, 83 vs. 52%, p = 0.007. Conclusion: ERCP-obtained bile cultures are a reliable and feasible mechanism to evaluate patients with suspected biliary tree infection. This technique has a significantly higher yield when compared to blood culture. Selection and tailoring of antibiotics based on bile culture in the management of ascending cholangitis are advised.

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“…This is similar to reported rates in prior studies [3][4][5]13]. These patients are often labeled as having bacteremic ascending cholangitis.…”

Section: Discussionsupporting

confidence: 80%

mentioning

confidence: 99%

Endoscopic Retrograde Cholangio-Pancreatography-Obtained Bile Culture Can Guide Antibiotic Therapy in Acute Cholangitis

Chandra

Klair

Soota

et al. 2018

Dig Dis

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“…5,6,7 In patients with bacteraemia, complications such as acute renal failure and septic shock occur more commonly, so an improved understanding of the causative organisms, susceptibility profiles results in better clinical outcomes. 8 The microorganisms predominantly found are Gram-negative aerobes like E. coli, Klebsiella, Proteus and Pseudomonas; Gram-positive cocci are also present like the Streptococci, Enterococci and Staphylococci. Anaerobes found in the bile are anaerobic streptococci, Clostridium welchii and Bacteroides fragilis.…”

mentioning

confidence: 99%

A Microbial Profile of Patients With Cholecystitis and/or Cholelithiasis Undergoing Cholecystectomy Along With Their Antibiogram

Garg¹,

Kumar²,

Parihar³

2016

jemds

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BACKGROUNDBiliary tract disease is common cause of bacteraemia, associated with high morbidity and mortality. Most common infecting organisms are from Enterobacteriaceae family. Complications of bacteraemia are acute renal failure & septic shock. MATERIALS AND METHODSThe study was conducted on 50 cases of cholelithiasis (who were admitted and treated in different units of General Surgery Department) and had undergone open or laparoscopic cholecystectomy. The samples collected were blood or bile, and then Gallstone Culture, Antibiogram Testing, Biochemical test (indole, methyl red, etc.) were performed. RESULTSGallstones disease was more common in females as compared to males (F:M:3.5: 1) and the maximum age incidence was in 41-50 years age group (38%). Pain abdomen was the predominant symptom present in 88% of cases, flatulent dyspepsia in 44% cases and nausea/vomiting in 32% cases, while tenderness in right hypochondrium was present in 44% of cases. Out of total 50 cases, 18 (36%) showed positive bile cultures and incidence of positive cultures increased with advancing age with maximum being positive in 41-60 years age group. Gallstone culture was positive in 28 cases (56%). Most common organism isolated from bile was E. coli (44% of positive cases) followed by Klebsiella (22%) and Pseudomonas (16%). CONCLUSIONSInfection plays a key role in pathogenesis of chronic calculous cholecystitis and bile and gallstone culture is a good method to demonstrate the infective potential of bacteria colonising the gall bladder.

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“…If monotherapy is decided Imipenem/Cilastatin, Ticarcillin/Clavulanic or Piperacilin/Tazobactam should be used. 26,27,28 The general use of radiological intervention techniques has been of great bene®t in the diagnosis and management of AAC. Gallbladder decompression by percutaneous cholecystostomy controlled by echography or by a CT scan can solve the situation with few complications, making cholecystectomy unnecessary.…”

Section: 11mentioning

confidence: 99%

Acute acalculous cholecystitis in patients with acute traumatic spinal cord injury

et al. 1997

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Acute acalculous cholecystitis (AAC) is a very serious complication which can be found in patients with multiple serious traumatic lesions (`polytrauma'). Very few patients have been reported in the literature with an acute spinal injury and associated AAC. We report seven patients with polytrauma and acute spinal cord injury who developed AAC. All had no complaint of the principal warning symptom: right upper quadrant abdominal pain. All presented with a palpable mass in this site and the laboratory results were compatible with cholestasis. The diagnosis of AAC was con®rmed both by ultrasound and CT scanning. We discuss the possible precipitating factors and the treatment. One hundred and ninety one patients were admitted to the Intensive Care Unit in our Hospital with SCI over a period of 2 years, all of these in the acute stage. AAC was diagnosed in seven patients among them. Our purpose is to call attention to this clinical condition which can complicate the outcome of patients with multiple trauma and acute spinal cord injury. To date AAC in this group of patients has been infrequently described in the available literature.

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Septic Acute Cholecystitis

Abstract: Acute cholecystitis is not often complicated by bacteremia, but when bacteremia is present, morbidity and death more consistently ensue.

Cited by 45 publications

References 21 publications

Endoscopic Retrograde Cholangio-Pancreatography-Obtained Bile Culture Can Guide Antibiotic Therapy in Acute Cholangitis

Endoscopic Retrograde Cholangio-Pancreatography-Obtained Bile Culture Can Guide Antibiotic Therapy in Acute Cholangitis

A Microbial Profile of Patients With Cholecystitis and/or Cholelithiasis Undergoing Cholecystectomy Along With Their Antibiogram

Acute acalculous cholecystitis in patients with acute traumatic spinal cord injury

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