Open AccessThe Epidemiology and Etiology of Cholangitis After Kasai Portoenterostomy in Patients With Biliary Atresia
Author(s) -
Baek Seung Hwan,
Kang JiMan,
Ihn Kyong,
Han Seok Joo,
Koh Hong,
Ahn Jong Gyun
Publication year - 2020
Publication title -
journal of pediatric gastroenterology and nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 131
eISSN - 1536-4801
pISSN - 0277-2116
DOI - 10.1097/mpg.0000000000002555
Subject(s) - medicine , biliary atresia , incidence (geometry) , gastroenterology , ampicillin , enterococcus faecium , klebsiella pneumoniae , enterococcus , antibiotics , surgery , liver transplantation , microbiology and biotechnology , escherichia coli , biochemistry , chemistry , transplantation , physics , biology , gene , optics
Objectives: We investigated the incidence and characteristics of cholangitis after Kasai portoenterostomy (KPE) in patients with biliary atresia. We also examined the distribution and antimicrobial susceptibility patterns of the causative pathogens, which were isolated in sterile specimens, such as blood and ascites. Methods: A retrospective chart review was performed in patients with biliary atresia who underwent KPE at Severance Children's Hospital in Korea from 2006 to 2015. The Kaplan‐Meier method was used to assess the cumulative incidence of cholangitis. Results: Among the 160 included patients, there were 494 episodes of cholangitis in 126 patients (78.8%) during the study period. The cumulative incidence of cholangitis at 1 and 5 years after KPE was 75.5% and 84.2%, respectively, and cholangitis recurred in most cases (76.2%). The cumulative incidence of culture‐proven cholangitis at 1 and 5 years after KPE was 22.1% and 23.9%, respectively. Enterococcus faecium (27.7%) was the most prevalent pathogen, followed by Escherichia coli (14.9%), Enterobacter cloacae (10.6%), and Klebsiella pneumoniae (8.5%). Gram‐positive isolates (n = 19) showed low susceptibility to ampicillin (42.1%) and gentamicin (66.7%), and only 38.1% of Gram‐negative isolates (n = 21) were susceptible to cefotaxime. Conclusions: The present study is the largest to show the high incidence and characteristics of cholangitis after KPE in patients with biliary atresia. Enterococcus is a common pathogen of cholangitis after KPE and should be considered when choosing empiric antimicrobial therapy.