title: Microbiological analysis of sepsis complicating non-surgical biliary drainage in malignant obstruction.
abstract: Cholangitis with sepsis is a common complication of non-surgical biliary drainage and represents a difficult management problem. Microbiological data for 18 septic episodes in 15 patients following endoscopic biliary drainage (EBD) and 14 septic episodes in 14 patients following percutaneous transhepatic drainage (PTD) were reviewed. In the EBD group, all 18 patient episodes of sepsis had blood cultures and 10 had bile cultures obtained. In total, 17 gram-negative isolates and 5 gram-positive isolates were grown in the EBD sepsis group. All of the 14 PTD patients had bile cultures and 13 had blood cultures. In total, 23 gram-negative isolates and 26 gram-positive isolates were grown in the PTD sepsis group. When PTD cultures were compared with EBD cultures, there were significantly more gram-positive cultures (26 vs. 5) associated with PTD sepsis than EBD sepsis (p less than 0.0005). Analysis of the antibiotic sensitivities revealed that a combination of ticarcillin clavulanate with gentamicin covered 20 of the 22 (91%) EBD organisms and 38 of the 49 (78%) PTD organisms. Based on this data, ticarcillin clavulanate with gentamicin is the therapy of choice for EBD and PTD sepsis at our institution.
authors.affiliation: Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
authors.forename: J G
authors.initials: JG
authors.lastname: Levine
authors.forename: J
authors.initials: J
authors.lastname: Botet
authors.forename: R C
authors.initials: RC
authors.lastname: Kurtz
mesh_terms: D000368:Aged; D002761:Cholangitis / Q000382:microbiology*; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D004322:Drainage / Q000379:methods*; D004359:Drug Therapy, Combination / Q000494:pharmacology; D004926:Escherichia coli / Q000187:drug effects; D004927:Escherichia coli Infections / Q000382:microbiology*; D005260:Female; D005839:Gentamicins / Q000494:pharmacology; D006801:Humans; D007710:Klebsiella Infections / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D013982:Ticarcillin / Q000494:pharmacology
chemical_list: D005839:Gentamicins; D013982:Ticarcillin