Clinical characteristics, aetiology and mortality/recurrence risk factors of acute cholangitis in patients with and without biliary stent

Adrián Sousa; Ana Alonso-Herrero; María Teresa Pérez-Rodríguez; Olalla Lima; Antón Otero; Milagros Suárez; Rebeca Longueira; Lucía Martínez-Lamas; Andrés Nodar; Manuel Crespo

doi:10.1016/j.eimc.2020.07.010

Clinical characteristics, aetiology and mortality/recurrence risk factors of acute cholangitis in patients with and without biliary stent

Enferm Infecc Microbiol Clin (Engl Ed). 2020 Sep 23:S0213-005X(20)30264-0. doi: 10.1016/j.eimc.2020.07.010. Online ahead of print.

[Article in English, Spanish]

Affiliations

¹ Infectious Diseases Unit-Internal Medicine Department, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Vigo, Spain; Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), Hospital Álvaro Cunqueiro, Bloque Técnico, Estrada Clara Campoamor 341, Vigo (Pontevedra), Spain. Electronic address: asousadominguez@gmail.com.
² Medical Oncology Department, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Vigo, Spain.
³ Infectious Diseases Unit-Internal Medicine Department, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Vigo, Spain; Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), Hospital Álvaro Cunqueiro, Bloque Técnico, Estrada Clara Campoamor 341, Vigo (Pontevedra), Spain.
⁴ Infectious Diseases Unit-Internal Medicine Department, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Vigo, Spain.
⁵ Microbiology Department, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Vigo, Spain.

PMID: 32980185
DOI: 10.1016/j.eimc.2020.07.010

Abstract

Objectives: Acute cholangitis is one of the most frequent complications in patients carrying biliary stents. The aim of our study is to analyze the demographic and clinical characteristics, as well as the microbiological profile and evolution of patients with acute bacteremic cholangitis, comparing them based upon they were or not biliary stent carriers.

Methods: We performed a retrospective analysis of all consecutive patients over 18 years-old with a stent placement in our center between 2008 and 2017 were included. We compared them with our prospective cohort of patients with a diagnosis of acute bacteremic cholangitis. Primary outcome was 30-day mortality. Secondary outcome was clinical cure at day 7, 14-day mortality and 90-day recurrence.

Results: Two hundred and seventy-three patients were analyzed, including 156 in the stent-related (SR) and 117 in the stent not-related (SNR) group, respectively. Stent-related colangitis patients were younger, with more comorbidities and with a greater severity of infection. Escherichia coli and Klebsiella pneumonia were the most frequent isolation. Enterococcus spp. was the third most frequent isolation in SR group but were uncommon in SNR patients; where E. coli was the most prevalent microorganism. Septic shock (HR 3.44, 95% [CI 1.18-8.77]), inadequate empirical treatment (HR 2.65, 95% CI [1.38-.7.98]) and advanced neoplasia (HR 2.41, 95% CI [1.55-6.44]) were independent 30-day mortality risk factors. The 90-day recurrence rate significantly higher in those patients with stent-related cholangitis (29% vs. 13%, p=0.016) and stent replacement was associated with lower recurrence rate (HR 0.38, 95% CI [0.11-0.77]).

Conclusions: Clinical and microbiological profile, as well as outcome of patients with SR and SNR cholangitis were different. In SR group, recurrence rate was high and stent replacement was associated with a lower risk.

Keywords: Acute cholangitis; Bacteremic cholangitis; Biliary stent; Colangitis aguda; Colangitis bacteriana; Colangitis relacionada con el stent; Stent biliar; Stent-related cholangitis.