Analysis of patterns of bacteremia and 30-day mortality in patients with acute cholangitis over a 25-year period

Introduction: Acute cholangitis (AC) is a condition of bacterial infection in the biliary tract with a high mortality rate of around 10%. Direct association between presence of bacteremia and 30-day mortality among AC patients is sparsely investigated and remains unclear.

Aims and methods: Our aim was to investigate association between bacteremia and 30-day mortality among patients with AC included over a period of 25 years. All AC patients that underwent endoscopic retrograde cholangiopancreatography (ERCP) at Odense University Hospital, between January 1 1990 and October 31 2015, were identified using a prospective ERCP database. Blood culture results from the patients along with antimicrobial resistance patterns were collected from a bacteremia research database.

Results: During the study period, 775 consecutive AC patients underwent ERCP and blood cultures were collected from 528 patients. Among these patients 48% (n=260) had bacteremia. Overall, 30-day mortality in patients with blood cultures performed was 13% (n=69). In patients with bacteremia, 30-day mortality was 19% (n=49), compared to 7% (n=20) in patients without bacteremia (p<0.01). Presence of bacteremia was associated with increased 30-day mortality (OR [95% CI]: 3.43 [1.92-6.13]; p<0.01) following adjustment for confounding factors. Among the species, bacteremia with Enterobacter cloacae was significantly associated with increased 30-day mortality (OR [95% CI]: 2.97 [1.16-7.62]; p=0.02).

Conclusion: Our results indicate that presence of bacteremia was associated with a nearly fourfold increase in 30-day mortality among AC patients.