Thompson et al studied risk factors associated with treatment failure in patients with acute cholangitis. The authors are from UCLA and Johns Hopkins Hospitals.
Patients:
(1) 127 adults with mean age of 57.2 years, with equal numbers of males and females.
(2) All had clinical evidence of acute cholangitis.
(3) All had obstruction of the biliary tract.
Therapy:
(1) antibiotic therapy (a penicillin + aminoglycoside, or a broad spectrum penicillin)
(2) biliary drainage, either by tube drainage or diverting procedures
Outcome criteria:
(1) Clinical cure: signs and symptoms of cholangitis completely abated with no evidence of infection in the followup period.
(2) Improved: significant improvement in the clinical findings but not complete resolution of the infection.
(3) Relapse: initial improvement but with recurrent infection within 3 weeks of therapy.
(4) Failure: no demonstrable response to therapy or the development of a significant post-operative infection in patients undergoing an operation.
Parameters identified by multivariate analysis:
(1) bile duct obstruction due to malignancy
(2) pan-resistant organisms (Candida species, etc.)
(3) >= 2 bacterial isolates in culture
(4) bacteremia
(5) elevated bilirubin (>= 2.2 mg/dL)
|
Parameter |
Odds Ratio |
|
malignancy |
1.93 |
|
pan-resistant organisms |
3.55 |
|
>= 2 bacterial isolates |
5.93 |
|
bacteremia |
8.14 |
|
elevated bilirubin |
30.11 |
from Table 5, page 142
|
Malignancy |
Bacteremia |
Elevated Bilirubin |
Isolates >= 2 |
Percent Failure |
|
0 |
0 |
0 |
0 |
4% |
|
0 |
0 |
0 |
1 |
21.4% |
|
0 |
0 |
1 |
0 |
52.8% |
|
0 |
0 |
1 |
1 |
87.9% |
|
0 |
1 |
0 |
0 |
24.6% |
|
0 |
1 |
0 |
1 |
68.0% |
|
0 |
1 |
1 |
0 |
89.7% |
|
0 |
1 |
1 |
1 |
98.3% |
|
1 |
0 |
0 |
0 |
8.3% |
|
1 |
0 |
0 |
1 |
37.1% |
|
1 |
0 |
1 |
0 |
70.7% |
|
1 |
0 |
1 |
1 |
94% |
|
1 |
1 |
0 |
0 |
41.4% |
|
1 |
1 |
0 |
1 |
82.1% |
|
1 |
1 |
1 |
0 |
94.9% |
|
1 |
1 |
1 |
1 |
99.2% |
after Table 6, page 142
where:
• Pan-resistant organisms are not included in the table due to the time delay to perform susceptibility testing.
Specialty: Infectious Diseases, Gastroenterology
