Aeromonas infection in acute suppurative cholangitis: Review of 30 cases

Objectives: Aeromonads, though not common pathogens in biliary sepsis, caus ed 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 diag nosis of biliary sepsis were reviewed. Those who fulfilled the diagnostic c riteria for acute suppurative cholangitis and had positive bile or blood cu ltures 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 si multaneous recovery of the bacteria from blood, All except two isolates wer e 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%), Mos t patients improved after biliary decompression, Only three patients (10%) died, two had terminal malignancy and one had end-stage liver failure. No e xcess mortality was attributable to Aeromonas infection in biliary sepsis, Conclusions: Previous instrumentation facilitated ascending Aeromonas infec tion of the biliary tract from the gastrointestinal tract. Unlike early rep orts, our results showed that aeromonads did not adversely affect the clini cal outcome of acute suppurative cholangitis with successful drainage of bi liary obstruction, (C) 2000 The British Infection Society.