MOH Holdings Pte Ltd (MOHH)1, Tan Tock Seng Hospital2
Acute cholangitis (AC) is a potentially life-threatening infection involving the biliary system. The two commonest bacteria involved are Escherichia coli (EC) followed by Klebsiella pneumoniae (KP). Microbiology is a prognostic factor for several pathologies but not for AC. We aim to compare clinical outcomes between KP bacteremia vs EC bacteremia in AC.
This is a retrospective cohort study of patients diagnosed with calculous AC (January-December 2016). Study outcomes include length of hospitalization stay, in-hospital mortality, 30-day, and 90-day mortality. Univariate and multivariate logistic regression was used to establish correlations.
We included 141 patients (KP (n=29), EC (n=112)) with overall median age of 82.2 and similar gender distribution. Sixty patients (42.6%) had diabetes mellitus. Seventy-one (50.4%) patients had a history of biliary disease. Most patients had Grade II AC (n=59, 41.8%). Patient demographics were comparable. KP bacteremia had higher median platelet count (KP:168×109/L vs EC:200×109/L; p=0.025). Overall median length of hospitalization stay is 9 days. Overall in-hospital, 30-day and 90-day mortality were 5.0%, 9.2%, and 10.6% respectively. Multivariate analysis showed KP bacteremia had higher 90-day mortality (Odds ratio (OR) 4.25 (95% Confidence Interval (CI):1.08-16.81); p=0.039) and in-hospital mortality (OR 46.41 (95% CI: 3.05-706.95); p=0.006). Length of hospitalization stay was comparable (KP 10 days vs EC 9 days, p=0.438). Subgroup analysis of endoscopic retrograde cholangiopancreatogram patients showed comparable outcomes.
KP bacteremia is associated with lower platelet count and higher mortality than EC. More studies are required to establish if inferior outcomes of KP bacteremia are associated to antimicrobial resistance.