Original articleClinical characteristics, aetiology and mortality/recurrence risk factors of acute cholangitis in patients with and without biliary stentCaracterísticas clínicas, etiología y factores de riesgo de mortalidad/recidiva de la colangitis bacteriana aguda en pacientes con y sin stent biliar
Introduction
Biliary stents are commonly used as a palliative treatment of obstructive jaundice in patients with unresectable biliary or pancreatic neoplasias. It has also been indicated in patients with non-malignant obstruction of the bile duct or as a previous step to surgery in patients with resectable neoplasias.1 There are different types of biliary stents (plastic vs. metallic, covered vs. uncovered), with different safety profile and risk of complications. Over time and inevitably, these stents are colonized by microorganisms (fungi and bacteria) that promote the occlusion of the device and increase the risk of cholestasis and acute cholangitis.2, 3
Acute bacteremic cholangitis continues to be a frequent cause of morbidity and mortality in these patients. Elderly patients with solid organ tumors are particularly susceptible,4, 5 with a crude mortality rate of around 11–26%.6, 7 Although some authors have pointed out a greater frequency of colonization of biliary stents by Enterococcus sp. and yeast,8, 9 there is very little information regarding the etiology, management, as well as, prognosis of patients with acute cholangitis related to the presence of a biliary stent.10 In the largest published series,11 a multicenter retrospective study conducted in Japan and Taiwan included more than 6,400 patients with acute cholangitis included, only 16% were carriers of a biliary stent and comparative analysis with non-carriers was not performed.
The aims of our study were to analyze the demographic and clinical characteristics, as well as the microbiological profile and evolution of patients with acute bacteremic cholangitis, comparing patients based upon they were or not biliary stent carriers.
Section snippets
Methods
All consecutive patients over 18 years-old with a stent placement in our center between January 1st 2008 and December 31st 2017 were included. Data were collected retrospectively by reviewing medical electronic records. Only patients with acute bacteremic cholangitis (those who met diagnostic criteria of Tokyo Guidelines 201812) were analyzed. Moreover, we also included all patients with a diagnosis of acute bacteremic cholangitis prospectively collected between October 1st 2015 and October
Results
During the study period 273 patients met eligibility criteria (8 patients were excluding due to missing data), including 156 in the stent-related group (SR) and 117 in the stent not-related (SNR) group. The main demographic, clinical, treatment and outcome characteristics of both group of patients are shown in Table 1. Stent-related acute cholangitis affected more commonly to male and younger patients, with more comorbidities and with a greater severity of infection. The type of stent used was
Discussion
In this study, we have performed a comparative analysis of a cohort of patients with and without biliary stent with acute bacteremic cholangitis.
It was observed that the group of patients with biliary stent were younger, but with more comorbidities, a higher prevalence of advanced solid organ tumors and with a greater severity of infection. In previous studies10, 11 comparing the etiology of both groups of patients (SR vs. SNR groups), differences in demographic, clinical characteristics, as
Authors contributions
AS, AAH, MTPR conceived and designed the study. AS, AAH, OL, AO, MS performed the scientific literature search, collected data, interpreted data. AS, AAH and MTPR wrote the report. All the authors approved the final version of the manuscript. As corresponding author AS had full access to all the data in the study and takes responsibility for the decision to submit for publication.
Funding
No external funding was received for the submitted work.
Conflicts of interest
All the authors have completed the ICMJE form for Disclosure of Potential Conflicts of Interest and declare that (1) AS reports personal fees from Pfizer, Angelini and Merck, outside the submitted work. MTPR reports personal fees from Pfizer and Merck, Astellas and Angelini outside the submitted work. The others authors have nothing to disclose; (2) None of the authors have had relationships in the previous two years with companies that might have an interest in the submitted work; (3) None of
Acknowledgments
Partial data of the submitted work was presented at 29th European Congress on Clinical Microbiology and Infectious Diseases (ECCMID 2019) with abstract numbers 1580 and 1585.
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