Clinical and Bacteriological profiles of patients with Acute Cholangitis.

Manoj Kumar, Sahu (2009) Clinical and Bacteriological profiles of patients with Acute Cholangitis. Masters thesis, Christian Medical College, Vellore.

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Abstract

INTRODUCTION : Acute cholangitis, is an infection of the biliary system with a wide spectrum of clinical presentations. In its most severe form, it is life threatening and associated with significant morbidity and mortality. Stone in the CBD is the most common cause of acute cholangitis. Other causes of cholangitis are neoplasm, benign strictures, parasitic infections, post operative conditions like sump syndrome and post choledochoduodenostomy and congenital anomalies of the bile ducts. In patients with bacterial cholangitis, bacteremia is seen in 1/3rd of blood cultures. Over two-thirds of the bile cultures show mixed infection of two or more organisms. Empiric broad- spectrum antibiotics and prompt biliary decompression, the mainstay of therapy significantly improves outcomes. There is no study from India which compares etiology, microbiological profile, interventions and outcomes in patients with acute cholangitis from different regions of the country. There is also no Indian data evaluating anaerobic cultures (blood / bile) in patients with acute cholangitis. Aims and Objectives : 1) To study the etiological profile, clinical features, interventions and outcomes in patients with acute cholangitis from different regions of the country. 2) To study the bacteriological profile (aerobic and anaerobic) and antibiotic sensitivity in a subset of prospectively enrolled patients with acute cholangitis. CONCLUSIONS : The most common cause of biliary obstruction in patients with acute cholangitis is stone disease (Choledocholithiasis). Malignant disease is responsible for obstruction in 1/3 of patients. Ultrasound examination of abdomen is an effective, inexpensive and non-invasive test for diagnosis of biliary obstruction. It should be the initial imaging test performed in patients with acute cholangitis. Bacteremia with single organisms (Gram negative) is seen in 1/3rd of patients with acute cholangitis, Gram positive organisms are rare in blood cultures. More than 90% of bile cultures show positive growth with multiple organisms in 2/3rd of the cultures. Most common organisms are E.coli and Enterococcus, followed by Klebsiella and Pseudomonas. The bacteriological profile has not changed over time. It is the same in our patients over the past 5 years. Anaerobic bacteria were not grown in bile or blood in the present study.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Acute Cholangitis ; Clinical ; Bacteriological profiles ; patients.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 14 Jul 2017 04:17
Last Modified: 14 Jul 2017 04:17
URI: http://repository-tnmgrmu.ac.in/id/eprint/1627

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