title: [Bacteremic colangitis in adults in a general hospital in Chile].
abstract: BACKGROUND
  Some aspects of bacteremic cholangitis are unknown in Chile.
  
  
  OBJECTIVE
  To gather more information on clinical, microbiological aspects as well as risk factors for ICU admission, recurrence and antimicrobial resistance.
  
  
  METHODS
  A retrospective research was performed using medical records of adult patients in a general hospital.
  
  
  RESULTS
  Between 2006-2012, 22 patients with 29 bacteremic events were identified. Previous cholangitis events were reported by 27.3%, 45.5% had recent admissions and, 50% had used antimicrobial compounds. Coledocholithiasis was the most common cause of obstruction (45.5%) followed by cancer (36.4%). One third developed shock (31%), the only factor associated with ICU admission (OR 30, p < 0.05). In 24 of the 29 bacteremic events, the biliary tract was intervened (82.8%) and in 80.8% during the first 72 hours. Gram negative bacilli were predominant (> 80%) and some infrequent agents such as Staphylococcus warneri, Shewanella spp. and, Aeromonas spp. were observed. Among enteric gram negative bacilli, 29.2% presented fluoroquinolone resistance and, 26.1% resistance to third generation cephalosporins, both associated with previous endoscopic retrograde cholangiography (OR 35 and 16.5, respectively p < 0.05). A favorable response was observed in 93.1% of bacte-remic events but in 31.8% of patients cholangitis recurred with or without bacteremia. Recurrence was associated to recent admission (OR 16.5, p = 0.01) and in all cases occurred before 81 days. In-hospital mortality was 9.1% (n = 2), but in only one case associated to sepsis. Average length of stay (LOS) was 17.8 days.
  
  
  CONCLUSIONS
  Early intervention of the biliary tract allows a favorable response in patients affected by bacteremic cholangitis, but this condition use intensive care resources, had a prolonged LOS, a recurrent pattern, and is associated with several bacterial species, some of them resistant.
authors: Servicio de Infectología, Departamento de Medicina, Hospital Militar de Santiago, Santiago, Chile. albertofica@gmail.com
authors: Alberto
authors: A
authors: Fica
authors: Verónica
authors: V
authors: Julio
authors: Estefanía
authors: E
authors: Palma
authors: Dannette
authors: D
authors: Guinez
authors: Lorena
authors: L
authors: Porte
authors: Stephanie
authors: S
authors: Braun
authors: Jeannette
authors: J
authors: Dabanch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D002677:Chile; D002761:Cholangitis / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D006094:Gram-Positive Bacteria / Q000187:drug effects; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents