title: Aeromonas infection in acute suppurative cholangitis: review of 30 cases.
abstract: OBJECTIVE
  Aeromonads, though not common pathogens in biliary sepsis, caused substantial mortality in patients with impaired hepatobiliary function. Our aim was to study the pathogenic role of Aeromonas in acute suppurative cholangitis.
  
  
  METHODS
  Between 1996 and 1998, the medical records of patients with a diagnosis of biliary sepsis were reviewed. Those who fulfilled the diagnostic criteria for acute suppurative cholangitis and had positive bile or blood cultures for Aeromonas species were studied.
  
  
  RESULTS
  One thousand and forty-five patients were confirmed to have acute suppurative cholangitis. Of these, 30 patients (2.9%) had Aeromonas species isolated from bile; four were complicated by aeromonas septicaemia with simultaneous recovery of the bacteria from blood. All except two isolates were A. hydrophila. Twenty-four patients (80%) had bile duct stones, four (13%) had cholangiocarcinoma and two (7%) pancreatic cancer. Twenty-five cases (83%) had previous exploration of the biliary tract. There was substantial resistance to piperacillin (58%), ceftazidime (30%) and imipenem (15%). Most patients improved after biliary decompression. Only three patients (10%) died, two had terminal malignancy and one had end-stage liver failure. No excess mortality was attributable to Aeromonas infection in biliary sepsis.
  
  
  CONCLUSIONS
  Previous instrumentation facilitated ascending Aeromonas infection of the biliary tract from the gastrointestinal tract. Unlike early reports, our results showed that aeromonads did not adversely affect the clinical outcome of acute suppurative cholangitis with successful drainage of biliary obstruction.
authors.affiliation: Department of Medicine & Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin.
authors.forename: F K
authors.initials: FK
authors.lastname: Chan
authors.forename: J Y
authors.initials: JY
authors.lastname: Ching
authors.forename: T K
authors.initials: TK
authors.lastname: Ling
authors.forename: S C
authors.initials: SC
authors.lastname: Chung
authors.forename: J J
authors.initials: JJ
authors.lastname: Sung
mesh_terms: D000208:Acute Disease; D000333:Aeromonas / Q000187:drug effects / Q000302:isolation & purification* / Q000472:pathogenicity; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001646:Bile / Q000382:microbiology; D001769:Blood / Q000382:microbiology; D002761:Cholangitis / Q000382:microbiology*; D003470:Culture Media; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology*; D006801:Humans; D008826:Microbial Sensitivity Tests; D013492:Suppuration
chemical_list: D000900:Anti-Bacterial Agents; D003470:Culture Media