Objectives

Acute cholangitis is one of the most frequent complications in patients carrying biliary stents. The aim of our study is to analyze the demographic and clinical characteristics, as well as the microbiological profile and evolution of patients with acute bacteremic cholangitis, comparing them based upon they were or not biliary stent carriers.

Methods

We performed a retrospective analysis of all consecutive patients over 18 years-old with a stent placement in our center between 2008 and 2017 were included. We compared them with our prospective cohort of patients with a diagnosis of acute bacteremic cholangitis. Primary outcome was 30-day mortality. Secondary outcome was clinical cure at day 7, 14-day mortality and 90-day recurrence.

Results

Two hundred and seventy-three patients were analyzed, including 156 in the stent-related (SR) and 117 in the stent not-related (SNR) group, respectively. Stent-related colangitis patients were younger, with more comorbidities and with a greater severity of infection. Escherichia coli and Klebsiella pneumonia were the most frequent isolation. Enterococcus spp. was the third most frequent isolation in SR group but were uncommon in SNR patients; where E. coli was the most prevalent microorganism. Septic shock (HR 3.44, 95% [CI 1.18–8.77]), inadequate empirical treatment (HR 2.65, 95% CI [1.38–.7.98]) and advanced neoplasia (HR 2.41, 95% CI [1.55–6.44]) were independent 30-day mortality risk factors. The 90-day recurrence rate significantly higher in those patients with stent-related cholangitis (29% vs. 13%, p = 0.016) and stent replacement was associated with lower recurrence rate (HR 0.38, 95% CI [0.11–0.77]).

Conclusions

Clinical and microbiological profile, as well as outcome of patients with SR and SNR cholangitis were different. In SR group, recurrence rate was high and stent replacement was associated with a lower risk.

中文翻译：

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胆道支架植入与未植入患者急性胆管炎的临床特征、病因及死亡/复发危险因素

目标

急性胆管炎是胆道支架患者最常见的并发症之一。我们研究的目的是分析急性菌血症性胆管炎患者的人口统计学和临床​​特征，以及微生物学特征和演变，根据他们是否为胆道支架携带者进行比较。

方法

我们对 2008 年至 2017 年间在我们中心放置支架的所有 18 岁以上连续患者进行了回顾性分析。我们将他们与诊断为急性菌血症性胆管炎的前瞻性队列进行了比较。主要结果是 30 天死亡率。次要结果是第 7 天的临床治愈、14 天死亡率和 90 天复发率。

结果

分析了 273 名患者，分别包括支架相关 (SR) 组 156 名和支架无关 (SNR) 组 117 名。支架相关性结肠炎患者更年轻，合并症更多，感染更严重。大肠杆菌和肺炎克雷伯菌是最常见的分离菌。肠球菌属 是 SR 组中第三大最常见的隔离，但在 SNR 患者中并不常见；其中大肠杆菌是最普遍的微生物。感染性休克（HR 3.44, 95% [CI 1.18-8.77]）、经验性治疗不足（HR 2.65, 95% CI [1.38-.7.98]）和晚期肿瘤（HR 2.41, 95% CI [1.55-6.44]）是独立的 30 天死亡率危险因素。支架相关性胆管炎患者的 90 天复发率显着更高（29% vs. 13%，p  =  0.016）并且支架置换与较低的复发率相关（HR 0.38，95% CI [0.11–0.77]）。

结论

SR 和 SNR 胆管炎患者的临床和微生物学特征以及结果不同。SR 组复发率高，支架置换风险较低。