Thesis (M.Sc.)-Cairo University - Faculty of Medicine - Infectious Diseases and Endemic Hepatogastroentrolyog

Bibliography: p. 81-96.

Introduction: Acute cholangitis is a fatal disease if not treated urgently which are often observed in patients with obstructive jaundice mostly caused by gall bladder stones or malignancy.Antimicrobial therapy is a corner stone in the treatment of acute cholangitis and should be started empirically until organism isolates and sensitivity are available. Aim of the Work: This study aimed at identifying the local microbial profile in the patients with acute cholangitis and their antibiotic sensitivity at our center which will allow giving most appropriate empirical antibiotic which may be lifesaving in patients with acute cholangitis. Methods:This is a descriptive cross sectional study that included 72 patients diagnosed with acute cholangitis according to Tokyo guidelines (TG18/TG13) criteria, divided into two groups newly admitted (community acquired) and those who develop cholangitis after 72 hours of admission (hospital acquired).Allpatients underwent the following investigations: Abdominal US and laboratory tests including CBC differential count, CRP, PT, PC, INR, liver tests and bile culture and sensitivity (samples are obtained by ERCP or PTBD). The demographic, clinical and laboratory CHARacteristics of the patients were recorded. Results:50 Bile Cultures (69.4 %) of 72 patients had positive growth, with 38 having benign diseases and 34 having malignant disorders 42 (84%) of the 50 positive samples had a single bacterial infection, while 8 (16%) had a mixed infection.A total of 54 species were discovered. There were 49 Gram-negative cultures, 3 Gram-positive bacterial cultures, and 2 fungal growths. The most frequent Gram-negative bacteria were Klebsiellapneumoniae (19, 35.8%), Escherichia coli (12, 22.6 %)and Pseudomonasaeruginosa (10, 18.8 %) Enterococcus faecalis, coagulase negative staptylococcusaureus and non heamolytic streptococcus were the three isolated gram positive organisms.The two isolated fungi were Candida albicans (1, 0.018%) and Candida galbrata (1, 0.018%).No anaerobic bacteria were isolated. Polymyxin B, ,Colistinsulphate, Imipenem, Tigecycline, Amikacin, Gentamicin, Meropenem, sensitivity was found to be broad or high. Conclusion: This the first study to investigate microbial profile and antibiotic sensitivity of acute cholangitis patients at our center thus, knowledge of the antimicrobial susceptibility data could aid in the better use of antibiotics for the empirical therapy of biliary infection combined with malignant and benign biliary obstruction.