Identifying and Treating Ascending Cholangitis: A case report and review of literature.

Acute cholangitis is an infection of the biliary system that typically results from obstruction. Common causes include choledocholithiasis, strictures, foreign bodies (such as biliary stents) parasitic worms (e.g. ascarids) and compression from an external structure. Obstruction allows for higher bacterial concentrations and bacterial proliferation. With biliary stasis and increases in intraductal pressure, bacteria migrate into the venous and lymphatic systems with subsequent bacteremia. The rate of gallstone development is 3-4 % annually in those >60 years old with up to a 15% overall prevalence in the US. In the US, 85% of ascending cholangitis cases are a consequence of choledocholithiasis. The gram-negative bacteria E coli, Klebsiella, Pseudomonas and Enterobacter are the most commonly identified pathogens. Anaerobes are less common.Ascending cholangitis is classically diagnosed by the presence of Charcot’s triad – fever, right upper quadrant pain and jaundice. Though very specific, the presence of Charcot’s triad is only 26% sensitive and thus its absence does not rule out the diagnosis. All patients with suspected ascending cholangitis should undergo appropriate fluid resuscitation, be given broad spectrum antibiotics to cover the likely enteric pathogens, and closely monitored for worsening in their clinical condition.Once initial assessment is complete and resuscitative efforts begun, imaging is often helpful in confirming the diagnosis of ascending cholangitis. After the diagnosis has been confirmed, ERCP and biliary drainage is indicated.

Download Full-text

Diagnostic and Therapeutic Value of ERCP in Acute Cholangitis

ISRN Gastroenterology ◽

10.1155/2013/191729 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 9

Author(s):

Kenan Buyukasik ◽

Ahmet Burak Toros ◽

Hasan Bektas ◽

Aziz Ari ◽

Mehmet Mehdi Deniz

Keyword(s):

Bile Ducts ◽

Acute Cholangitis ◽

Complication Rates ◽

Endoscopic Retrograde ◽

Therapeutic Success ◽

Mortality And Morbidity ◽

E Coli ◽

Therapeutic Value ◽

Ascending Cholangitis ◽

Biliary Ducts

Cholangitis, with a clinical spectrum between acute ascending cholangitis and acute fulminant cholangitis, the mildest and the most severe forms, respectively, is the infection of bile ducts with a potential of serious mortality and morbidity. Obstruction of the bile ducts followed by infection, with E. coli being the most commonly isolated agent, is common to all forms of cholangitis. Biliary obstruction is caused by choledocholithiasis mostly. “Choledochal pressure” is the most important factor, determining morbidity. If the pressure exceeds 25 cm H2O, which is the critical value, immune dysfunction ensues. Sepsis is common if the infection of biliary ducts is suppurative. Mortality and morbidity are inevitable if left untreated or drained late. The objective of this study is, in the stand point of the current literature, to analyse the diagnostic, therapeutic success and complication rates of ERCP (Endoscopic retrograde cholangiopancreatography) in patients with a diagnosis of acute purulent cholangitis with no response to medical treatment.

Download Full-text

Antimicrobial Effects of Zataria multiflora and Ocimum basilicum on Escherichia coli O157:H7 During Ripening of Traditional Lighvan Cheese

Current Nutrition & Food Science ◽

10.2174/1573401315666181218151541 ◽

2020 ◽

Vol 16 (3) ◽

pp. 373-380

Author(s):

Mohammad B. Zendeh ◽

Vadood Razavilar ◽

Hamid Mirzaei ◽

Khosrow Mohammadi

Keyword(s):

Escherichia Coli ◽

Essential Oils ◽

Dairy Products ◽

Antimicrobial Agents ◽

Escherichia Coli O157 ◽

Zataria Multiflora ◽

Antimicrobial Effects ◽

E Coli ◽

Common Causes ◽

Lighvan Cheese

Background: Escherichia coli O157:H7 is one of the most common causes of contamination in Lighvan cheese processing. Using from natural antimicrobial essential oils is applied method to decrease the rate of microbial contamination of dairy products. The present investigation was done to study the antimicrobial effects of Z. multiflora and O. basilicum essential oils on survival of E. coli O157:H7 during ripening of traditional Lighvan cheese. Methods: Leaves of the Z. multiflora and O. basilicum plants were subjected to the Clevenger apparatus. Concentrations of 0, 100 and 200 ppm of the Z. multiflora and 0, 50 and 100 ppm of O. basilicum essential oils and also 103 and 105 cfu/ml numbers of E. coli O157:H7 were used. The numbers of the E. coli O157:H7 bacteria were analyzed during the days 0, 30, 60 and 90 of the ripening period. Results: Z. multiflora and O. basilicum essential oils had considerable antimicrobial effects against E. coli O157:H7. Using the essential oils caused decrease in the numbers of E. coli O157:H7 bacteria in 90th days of ripening (P <0.05). Using from Z. multiflora at concentration of 200 ppm can reduce the survival of E. coli O157:H7 in Lighvan cheese. Conclusion: Using Z. multiflora and O. basilicum essential oils as good antimicrobial agents can reduce the risk of foodborne bacteria and especially E. coli O157:H7 in food products.

Download Full-text

Complications due to Biliary Stent Deviation

Austin Journal of Gastroenterology ◽

10.26420/austinjgastroenterol.2021.1112 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Kinoshita Kumar ◽

◽

Fukuchi S ◽

Murakami K ◽

◽

...

Keyword(s):

Computed Tomography ◽

Endoscopic Sphincterotomy ◽

Clinical Symptoms ◽

Acute Cholangitis ◽

Biliary Stent ◽

Plastic Stents ◽

Duodenal Perforation ◽

Early Complications ◽

Biliary Stents ◽

Uterine Appendage

We often encounter complications from biliary stents used as a treatment for obstructive jaundice and acute cholangitis. Early complications after stent placement include pancreatitis, bleeding, and duodenal perforation [1]. Stent deviation is also a complication. This is particularly prominent for plastic stents, where stent deviation is observed in 6-18.7 % of cases [2]. Stent deviation is more common among patients who have undergone endoscopic sphincterotomy (Figure 1). Most deviated biliary plastic stents are excreted in stool or collected endoscopically, but, very rarely, complications causing gastrointestinal perforation have been reported. We have described deviated biliary plastic stents causing sigmoid colon diverticulum perforation and even uterine appendage penetration (Figure 2). Diagnosis can be made from clinical symptoms and abdominal computed tomography. Treatment is basically surgery. Biliary stent-related complications are inevitable, and sometimes become serious. On suspicion of such complications, the most important issue is to accurately and rapidly diagnose complications and conduct appropriate management.

Download Full-text

Development and Optimization of a Neonatal Rat Model of Sepsis

Journal of Pediatrics & Neonatal Biology ◽

10.33140/jpnb.03.01.05 ◽

2018 ◽

Vol 3 (1) ◽

Keyword(s):

Blood Culture ◽

Rat Model ◽

Neonatal Sepsis ◽

Neonatal Rat ◽

Neonatal Rats ◽

Minimum Effective Dose ◽

Biochemical Tests ◽

E Coli ◽

Common Causes ◽

Neonatal Rat Model

Neonatal sepsis is the most common cause of mortality in newborns. Currently antibiotics and supportive care are the mainstay of treatment. Blood culture is considered as the gold standard for confirmation of diagnosis of neonatal sepsis. Here we have tried to develop a neonatal rat model of sepsis in order to better understand its progression. Lipopolysaccharide (LPS) is one of the common agents used to induce sepsis in rats. Here we found that LPS was ineffective in inducing sepsis in neonatal rats. We found that induction of live dose of Escherichia coli, one of the most common causes of neonatal sepsis was more effective than LPS injection. The rats were continuously monitored for the visual indications of sepsis development. Body weight, body temperature and the activity of rats were monitored continuously. Blood culture was done to check for the confirmation of diagnosis of sepsis. Further biochemical tests such as citrate, urease, indole and kliger-ion tests were done to confirm for E coli in the colonies of blood culture. The minimum effective dose of E coli needed to induce sepsis in neonatal rats was found to be 5*106 CFU of E coli.

Download Full-text

Prescribing of different antibiotics, rates of sepsis-related mortality and bacteremia in the US and England, and the utility of antibiotic replacement vs. reduction in prescribing: a cross-sectional study

10.21203/rs.2.10944/v1 ◽

2019 ◽

Cited By ~ 1

Author(s):

Edward Goldstein

Keyword(s):

Bacterial Infections ◽

Multivariable Analysis ◽

Age Groups ◽

Epidemiological Data ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Limited Information ◽

Cross Sectional ◽

E Coli ◽

The Us

Abstract Background Antibiotic use contributes to the rates of bacteremia, sepsis and associated mortality, particularly through lack of clearance of resistant infections following antibiotic treatment. At the same time, there is limited information on the effects of prescribing of some antibiotics vs. others on the rates of outcomes related to severe bacterial infections. Methods We looked at associations between the proportions (state-specific in the US; Clinical Commissioning Group (CCG)-specific in England) of different antibiotic types/classes among all prescribed antibiotics in the outpatient setting (oral antibiotics in the US), and rates of outcomes (mortality with sepsis, ICD-10 codes A40-41 present as either underlying or contributing causes of death on a death certificate in different age groups of US adults; E. coli as well as MSSA bacteremia in England) per unit of antibiotic prescribing (defined as the rate of outcome divided by the rate of outpatient prescribing of all antibiotics). Results In the US, prescribing of penicillins was associated with rates of mortality with sepsis for persons aged 75-84y and 85+y between 2014-2015. In England, prescribing of penicillins other than amoxicillin/co-amoxiclav was associated with rates of both MSSA and E. coli bacteremia for the period between financial years 2014/15 through 2017/18. Additionally, multivariable analysis for the US data has also shown an association between the percent of individuals aged 50-64y lacking health insurance, as well as the percent of individuals aged 65-84y who are African-American and rates of mortality with sepsis in the corresponding age groups. Conclusions Our results suggest that prescribing of penicillins is associated with rates of E. coli and MSSA bacteremia in England, and rates of mortality with sepsis in older US adults. Those results, as well as the related epidemiological data suggest that replacement of certain antibiotics, particularly penicillins in the treatment of certain syndromes should be considered for reducing the rates of outcomes related to severe bacterial infections.

Download Full-text

Management of afferent loop syndrome after Roux-en-Y subtotal gastrectomy and choledocolithiasis with recurrent cholangitis

BMJ Case Reports ◽

10.1136/bcr-2019-232498 ◽

2020 ◽

Vol 13 (1) ◽

pp. e232498

Author(s):

Fernando Azevedo ◽

Carolina Canhoto ◽

José Guilherme Tralhão ◽

Hélder Carvalho

Keyword(s):

Bile Flow ◽

Rare Complication ◽

Acute Cholangitis ◽

Subtotal Gastrectomy ◽

Bacterial Overgrowth ◽

Billroth Ii ◽

Afferent Loop ◽

Afferent Loop Syndrome ◽

Biliary Stasis ◽

Multiple Episodes

Afferent loop syndrome is a rare complication after gastrectomy with Billroth II or Roux-en-Y reconstruction, caused by an obstruction in the proximal loop. The biliary stasis and bacterial overgrowth secondary to this obstruction can lead to repeated episodes of acute cholangitis. We present the case of a male patient who had previously undergone gastrectomy with Roux-en-Y reconstruction and later experienced multiple episodes of acute cholangitis secondary to choledocolithiasis. He underwent an open exploration of the bile ducts with choledocolitotomy, but the events of cholangitis persisted. Further investigation permitted to identify a dilation of the biliary loop of the Roux-en-Y anastomosis, suggesting enterobiliary reflux as the cause of recurrent acute cholangitis. Therefore, a bowel enterectomy and new jejunojejunostomy were undertaken, and normal biliary flow was re-established. The surgical treatment is mandatory in benign causes, leading to the resolution of the obstruction and subsequent normalisation of bile flow.

Download Full-text

The hydrocholeretic bile acid dehydrocholic acid is a safe and moderately effective treatment for recurrent acute cholangitis due to biliary stasis

HPB ◽

10.1016/j.hpb.2019.03.323 ◽

2019 ◽

Vol 21 ◽

pp. S176-S177

Author(s):

S.M. Strasberg ◽

J.G. Grossman ◽

R.B. Sullivan ◽

T. Stoentcheva ◽

L.A. Worley

Keyword(s):

Bile Acid ◽

Effective Treatment ◽

Acute Cholangitis ◽

Dehydrocholic Acid ◽

Biliary Stasis

Download Full-text

Initial Assessment of the Molecular Epidemiology ofblaNDM-1in Colombia

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.03072-15 ◽

2016 ◽

Vol 60 (7) ◽

pp. 4346-4350 ◽

Cited By ~ 14

Author(s):

Laura J. Rojas ◽

Meredith S. Wright ◽

Elsa De La Cadena ◽

Gabriel Motoa ◽

Kristine M. Hujer ◽

...

Keyword(s):

Hot Spot ◽

Multidrug Resistant ◽

Sequence Type ◽

Initial Assessment ◽

Genome Sequences ◽

Gram Negative ◽

Content Type ◽

E Coli ◽

Resistance Determinants ◽

Novel Complex

ABSTRACTWe report complete genome sequences of fourblaNDM-1-harboring Gram-negative multidrug-resistant (MDR) isolates from Colombia. TheblaNDM-1genes were located on 193-kb Inc FIA, 178-kb Inc A/C2, and 47-kb (unknown Inc type) plasmids. Multilocus sequence typing (MLST) revealed that these isolates belong to sequence type 10 (ST10) (Escherichia coli), ST392 (Klebsiella pneumoniae), and ST322 and ST464 (Acinetobacter baumanniiandAcinetobacter nosocomialis, respectively). Our analysis identified that the Inc A/C2 plasmid inE. colicontained a novel complex transposon (Tn125and Tn5393with three copies ofblaNDM-1) and a recombination “hot spot” for the acquisition of new resistance determinants.

Download Full-text

Antimicrobial Susceptibility Profile of Extended Spectrum β-Lactamase (ESBL) Producing Escherichia coli from Various Clinical Samples

Infectious Diseases Research and Treatment ◽

10.4137/idrt.s13820 ◽

2014 ◽

Vol 7 ◽

pp. IDRT.S13820 ◽

Cited By ~ 11

Author(s):

Dinesh Kumar ◽

Amit Kumar Singh ◽

Mohammad Rashid Ali ◽

Yogesh Chander

Keyword(s):

Escherichia Coli ◽

Antimicrobial Susceptibility ◽

Clinical Laboratory ◽

Multi Drug Resistance ◽

Clinical Samples ◽

E Coli ◽

Antimicrobial Sensitivity ◽

Extended Spectrum ◽

Common Causes ◽

Hospital Acquired

Background Extended spectrum β-lactamase (ESBL) producing Escherichia coli has tremendously increased worldwide and it is one of the most common causes of morbidity and mortality associated with hospital-acquired infections. This could be attributed to association of multi drug resistance in ESBL producing isolates. The present study was aimed to determine the antimicrobial sensitivity profile of ESBL producing E. coli isolates from various clinical samples. Materials and Methods Clinical samples, which consist of pus, urine, blood, cerebrospinal fluid (CSF), stool, sputum, swabs, and different body fluids, are included in the study. Samples were processed and identified as per routine laboratory protocol. ESBL screening and confirmation along with antimicrobial susceptibility test was done according to the Clinical Laboratory Standards Institute (CLSI) guidelines. Results Out of 180 third generation cephalosporins resistant E. coli, 100 (55.55%) isolates were ESBL producers showing a greater degree of resistance to antibiotics. Conclusion The prevalence of ESBL is increasing day by day in nearly every center of different countries and necessary steps to prevent the spread and emergence of resistance should be taken.

Download Full-text