![]() ![]() All enrolled patients received standardized treatment in accordance with the Tokyo Guidelines, including the treatment with antimicrobials and anti-shock immediately, combined with ERCP (Endoscopic Retrograde Cholangiopancreatography) or surgical drainage to remove the biliary obstruction as soon as possible. Patients with community-acquired infection of acute cholangitis who met the diagnostic criteria of Tokyo Guidelines from July 2013 to July 2020 were selected. The Institutional Review Board of the First Affiliated Hospital of Chongqing Medical University approved this study. The First Affiliated Hospital of Chongqing Medical University (CHMU) is a Grade III, Grade A general hospital in China. In this retrospective observational study, all patients diagnosed with acute cholangitis admitted to the First Affiliated Hospital of Chongqing Medical University from July 2013 to July 2020 were investigated. This study used retrospective data collection and analysis for two purposes: (1) to compare between Gram-negative and Gram-positive infections in acute cholangitis in terms of severity and organ dysfunction to provide evidence support for guidelines and to suggest proper empirical antibiotics (2) to provide a prognostic evaluation of different types of bacterial infections in acute cholangitis and early prognostic judgment. monomicrobial bacterial infections in acute cholangitis. There are no reports on the comparison of mixed infections of Gram-negative and Gram-positive bacteria vs. After reviewing the literature, only a few reports compare the clinical features of Gram-negative and Gram-positive bacteria in acute cholangitis. The guidelines emphasized that severe cholangitis could be due to a mixed infection of Gram-negative and Gram-positive, but there is no evidence to support it. The 20 Tokyo guidelines state that if a patient develops severe cholangitis, the choice of empiric antibiotics should be anti-Gram-negative bacteria while covering Gram-positive bacteria. Currently, it is difficult for clinicians to determine the type of pathogens in acute cholangitis patients. Both Gram-negative and Gram-positive bacteria can cause serious infections, resulting in sepsis or septic shock. Patients could be infected by either a single pathogen or a mixture of Gram-negative and Gram-positive bacteria. The pathogens of acute cholangitis ascend from the intestinal tract, mainly Gram-negative bacilli and Gram-positive cocci. Timely biliary drainage and the use of appropriate antibiotics are the keys to improving the prognosis. Acute cholangitis has a high mortality rate up to 10% even after aggressive treatment. It is commonly related to biliary stones and biliary tract tumors it can cause septic shock and multiple organ dysfunction in severe cases. There were no apparent differences between Gram-negative and Gram-positive bacterial infections.Īcute cholangitis is an inflammation of the bile duct caused by biliary tract bacterial infection due to biliary tract obstruction. In acute cholangitis, mixed infection with Gram-negative and Gram-positive bacteria was more severe and was associated with a higher risk of death. ![]() The proportion of Grade III patients and the APACHE II and SOFA scores of the mixed Gram-negative and positive group were the highest (p 0.05). Among the 313 patients (73.8%) with bacterial growth, 155 patients had only Gram-negative bacteria cultured (49.5%), 48 patients had only Gram-positive bacteria cultured (15.3%), and 110 patients had both Gram-negative and Gram-positive bacteria cultured (35.1%). ResultsĪ total of 424 patients were included, and no bacterial growth developed in 111 patients (26.2%). The severity of illness, organ dysfunction, and prognosis of the groups were analyzed and compared comprehensively. Patients who met the selection criteria according to blood culture and bile culture results of different pathogenic bacterial were divided into groups. MethodsĪ retrospective observational study was performed. To investigate the difference in the severity of illness, organ dysfunction, and prognosis of acute cholangitis due to different pathogenic bacterial infection types.
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