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

Departments of Surgery, Olive View-UCLA Medical Center, UCLA School of Medicine, The Johns Hopkins Hospital, USA

Department 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 127patients was analyzed. There were 64 females and 63 males whose mean age was 57.2 years. Ninetyfour74.0% 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 inregard to age and gender. However, more patients in the group that failed had a malignant cause fortheir bile duct obstruction 72.7% vs. 42.6%, p < 0.01 and had a pretreatment positive blood culture45.5% 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 wereisolated per culture 3.88 vs. 2.86, p < 0.03 in the patients who failed. In addition, more patients failedwho had two or more organisms in the bile 33% vs. 8.3%, p < 0.02. Patients in whom Candida, or anypanresistant 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 bestpredictors of treatment failure with a serum bilirubin level ≥ 2.2 mg-dl being the variable that increasesa patient's log-odds ratio of failure the greatest. In conclusion, patients with acute cholangitis whohave an increased chance to fail initial therapy can be identified, and treatment altered accordingly.

Autor: Jesse Thompson, Robert S. Bennion, and Henry A. Pitt



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