Krige and Bornman listed risk factors associated with infectious complications following surgery on the biliary tract, including abscesses, wound infections and sepsis. A patient with one or more of these risk factors may benefit from more aggressive management, prophylactic antibiotics and closer monitoring. The authors are from Cape Town, South Africa.
Parameters:
(1) age
(2) bacteria in the bile (bactibilia, based on cultures taken during surgery)
(3) acute cholecystitis
(4) biliary obstruction
(5) common duct stones
(6) foreign material such as stents or tubes
(7) biliary-enteric anastomosis
(8) non-functioning gallbladder (associated with increased risk of bacteria in the bile)
(9) diabetes mellitus
(10) immunosuppression
|
Parameter |
Finding |
Points |
|
age of the patient |
<= 70 years of age |
0 |
|
|
> 70 years of age |
1 |
|
bile cultures taken at surgery |
negative |
0 |
|
|
positive (bactibilia) |
1 |
|
acute cholecystitis |
absent |
0 |
|
|
present |
1 |
|
biliary obstruction |
absent |
0 |
|
|
present |
1 |
|
stones in the common bile duct |
absent |
0 |
|
|
present |
1 |
|
foreign material in common bile duct |
absent |
0 |
|
|
present |
1 |
|
biliary-enteric anastomosis |
absent |
0 |
|
|
present |
1 |
|
gallbladder |
absent or functioning |
0 |
|
|
nonfunctioning |
1 |
|
diabetes mellitus |
absent |
0 |
|
|
present |
1 |
|
immunosuppression |
absent |
0 |
|
|
present |
1 |
where:
• Although not listed, I wonder if the presence of parasites such as Clonorchis would increase the risk of cholangitis.
total number of risk factors =
= SUM(points for all 10 risk factors)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 10
• The risk for infectious complications increases with increasing numbers of risk factors.
Specialty: Infectious Diseases, Gastroenterology
