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HPB Surgery
Volume 8 (1994), Issue 2, Pages 139-145

An Analysis of Infectious Failures in Acute Cholangitis

1Departments of Surgery, Olive View/UCLA Medical Center, UCLA School of Medicine, The Johns Hopkins Hospital, USA
2Department of Surgery, Olive View/UCLA Medical Center, 2B156, 14445 Olive View Drive, Sylmar 91342, California, USA

Copyright © 1994 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


To determine the factors responsible for therapeutic failures in acute cholangitis, a series of 127 patients was analyzed. There were 64 females and 63 males whose mean age was 57.2 years. Ninetyfour (74.0%) of these patients were clinically cured with initial measures, whereas 33 patients (26%) failed initial therapy for an infectious reason. No differences were observed between the two groups in regard to age and gender. However, more patients in the group that failed had a malignant cause for their bile duct obstruction (72.7% vs. 42.6%, p < 0.01) and had a pretreatment positive blood culture (45.5% vs. 13.8%, p < 0.01). Patients who failed had a higher mean total bilirubin level (9.7 mg/dl vs. 5.5 mg/dl, p < 0.005) and more of them had a level greater than 2.2 mg/dl (97% vs. 69.9%, p < 0.001). Also, more bile cultures were initially positive (93.9% vs. 76.6%, p < 0.05) and more organisms were isolated per culture (3.88 vs. 2.86, p < 0.03) in the patients who failed. In addition, more patients failed who had two or more organisms in the bile (33% vs. 8.3%, p < 0.02). Patients in whom Candida, or any panresistant organism was isolated also tended to fail. Multivariant analysis showed that malignancy, bacteremia, bilirubin ≥ 2.2 mg/dl, ≥ 2 organisms in the bile and a panresistant organism were the best predictors of treatment failure with a serum bilirubin level ≥ 2.2 mg/dl being the variable that increases a patient's log-odds ratio of failure the greatest. In conclusion, patients with acute cholangitis who have an increased chance to fail initial therapy can be identified, and treatment altered accordingly.