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Bacterial cholangitis after surgery for biliary atresia
Insights
Bacterial cholangitis frequently occurs after biliary atresia surgery, especially within 3 months. Early antibiotic use and bile flow restoration are associated factors, but prompt treatment is key.
Area of Science:
- Pediatric Surgery
- Hepatobiliary Surgery
- Infectious Diseases
Background:
- Biliary atresia is a severe neonatal liver disease requiring surgical intervention.
- Bacterial cholangitis is a significant postoperative complication following biliary atresia repair.
- Understanding cholangitis incidence and risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence of bacterial cholangitis in infants undergoing surgery for biliary atresia.
- To identify associated factors and clinical manifestations of cholangitis.
- To evaluate the effectiveness of different surgical approaches and antibiotic use.
Main Methods:
- Retrospective study of 129 infants operated on for biliary atresia over 5 years.
- Analysis of hepatic portoenterostomy cases (n=101) for cholangitis episodes.
- Review of clinical data, laboratory results, microbiological cultures, and surgical procedures.
Main Results:
- Forty-six of 101 infants (45.5%) who had hepatic portoenterostomy experienced 105 episodes of cholangitis, mostly within 3 months post-operation.
- Associated factors included restored bile flow, abnormal intrahepatic bile ducts, and routine postoperative antibiotics.
- Gram-negative bacteria were the most common pathogens; initial susceptibility was to trimethoprim-sulfamethoxazole and cephalosporins, decreasing to cephalosporins for later episodes.
- External jejunostomy did not prevent cholangitis.
Conclusions:
- Bacterial cholangitis is a common complication after hepatic portoenterostomy for biliary atresia.
- Early postoperative period and factors like bile flow restoration are critical.
- Antibiotic resistance patterns evolve, necessitating careful selection of antimicrobial agents.
- Cholangitis episodes did not increase the risk of portal hypertension in patients with normal bilirubin levels at age 5.
Abstract:
We retrospectively studied the incidence of bacterial cholangitis in 129 infants operated on because of biliary atresia over 5 years. Forty-six of the 101 children who underwent hepatic portoenterostomy had a total of 105 episodes of cholangitis (range one to eight episodes per child). Most episodes occurred within 3 months of the operation. Factors associated with cholangitis included good or partial restoration of bile flow, abnormal intrahepatic bile ducts or cavities at the porta hepatis, and routine postoperative use of antibiotics. External jejunostomy was not effective in preventing cholangitis. In addition to fever and decreased bile flow, increased erythrocyte sedimentation rate and signs of shock were frequently observed. The responsible organisms, most often gram-negative bacteria, were identified in 79 (75%) episodes by blood or liver cultures. Most were susceptible to trimethoprim-sulfamethoxazole and third-generation cephalosporins during the first episode, but only to cephalosporins during later episodes. The incidence of signs of portal hypertension in children with normal serum bilirubin values at age 5 years was not higher in those who had previously experienced one or more episodes of cholangitis.