Cholangitis | Spectrum

Defined as a triad of fever, jaundice and abdominal pain resulting from stasis and infection in the biliary tract

Diagnostic Pearls

Rapid surgical/gastroenterology consult for source control (e.g. ERCP, percutanious drainage)

Biliary tract cultures (positive in >90%) to guide therapy

Blood cultures in severely ill and health care associated cholangitis

Procalcitonin (PCT) not usually useful

Empiric Treatment:

Check one:

Mild-moderate

Those who do not meet criteria for severe infection but may have:

SIRS (two or more of: Temperature >38°C or <36°C; Heart rate >90/min; Respiratory rate >20/min; White blood cell count >12,000/mm3 or <4,000mm3)
Hyperbilirubinemia
Hypoalbuminemia
Co-morbidities (e.g. diabetes, advanced age)

Severe

Requiring ICU admission, or

Sepsis (life-threatening organ dysfunction e.g. hypotension, acute renal failure, caused by dysregulated host response to infection)

Check one:

Community acquired

Acquired in the outpatient setting

Health care-associated

Acquired more than 48 hours post admission, or

Hospitalization, surgery, regular outpatient visits (e.g. dialysis, chemotherapy) within last 90 days or residing in long term care

Check any, if present:

Stent in biliary tract OR previous biliary/gallbladder surgery

Biliary-enteric anastomosis

Usual Organisms

Enterobacteriaceae (E. coli, Klebsiella)

Streptococci, particularly viridans group strep

Less Common Organisms

Enteric anaerobic bacilli

Enterococci

Organisms of Interest in IAI