CLINICAL PROFILE OF PATIENTS WITH ACUTE CHOLANGITIS AND THEIR SIX TO EIGHTEEN MONTHS FOLLOWUP IN A TERTIARY CARE HOSPITAL OF NORTH INDIA.

Abstract

BACKGROUND: Cholangitis is an infection of biliary tract. Diagnosis is based on Tokyo guidelines. Escherichia Coli is commonest organism in bile cultures. The incidence of drug resistant microorganisms is rising and therefore, empirical therapy needs to get revised regularly. Treatment requires antibiotics and biliary drainage.

OBJECTIVES: To study clinical profile and followup of  patients with cholangitis.

PARTICIPANTS: Patients over 18 years with suspected cholangitis.

STUDY DESIGN: Prospective observational study.

METHODS: The study was conducted in SKIMS for 6-18 months. Inform consent taken. Investigations like LFT, CBC, bile cultures, USG, CT, MRCP etc. were done.

RESULTS: 30% cases had Grade I, 25% had grade II and 44% had grade III cholangitis. Escherichia Coli was predominant bacteria in bile cultures (78%). 37% cases had Malignant CBD obstruction. Risk factors associated with mortality were malignant etiology, grade and duration of illness. Incidence of drug resistant microorganisms was significant (51% of all culture positive cases). At the end of followup, 25% of patients died, 52% had resolution and 2% had persistence of infection.

CONCLUSIONS: Factors defining acute cholangitis are associated with its grade. Outcome is related to disease grade and type of bacteria in bile culture. Resistant bacteria are rising hence empirical therapy must be changed. Treatment requires biliary drainage and antibiotics.

IMPLICATIONS: Tokyo guidelines, 2018 are required to diagnose cholangitis. Bile culture for every patient is required to develop hospitals’ antibiogram in view of changing antibiotic susceptibility. Biliary drainage is the required treatment.