Clinical and Microbiological Profile of Patients With Acute Cholangitis in A Tertiary Care Centre: A Prospective Observational Study

Abstract

Background: Acute cholangitis is a potentially life-threatening biliary tract infection, usually associated with biliary obstruction. Microbiological characteristics and antimicrobial susceptibility patterns may vary by underlying aetiology and local epidemiology. This study evaluated the clinical and microbiological profile, severity, management, and outcomes of patients with acute cholangitis. Methods: A prospective observational study was conducted at King George Hospital, Visakhapatnam, from March 2023 to February 2024. Adults diagnosed with acute cholangitis according to clinical, biochemical, and imaging criteria were included. Data regarding demographics, aetiology, clinical features, severity according to Tokyo Guidelines 2018, laboratory parameters, microbiological findings, antimicrobial susceptibility, interventions, and outcomes were recorded. Blood and bile samples were subjected to aerobic and anaerobic culture and antimicrobial susceptibility testing. Statistical analysis was performed using SPSS. Results: A total of 78 patients were included, with a mean age of 42.73 ± 15.25 years; 47 (60.3%) were male. Grade II cholangitis was predominant (80.8%), followed by Grade III (15.4%) and Grade I (3.8%). Jaundice (92.3%), fever (91.0%), and abdominal pain (89.8%) were the predominant clinical features. Gallstone disease was the most common etiology (30.8%), followed by chronic pancreatitis (15.4%) and malignant biliary obstruction. Blood cultures were positive in 17.9% of patients, with Escherichia coli being the most frequent isolate (9.0%). Bile cultures were positive in 70.5%; E. coli (38.5%) and Klebsiella spp. (20.5%) were the predominant isolates, while Bacteroides spp. were identified in 7.6% of bile cultures. ERCP was performed in 91.0% of patients and PTBD in 9.0%. Overall mortality was 3.8%, with deaths occurring among patients with malignant obstruction and Grade III cholangitis. Malignant obstruction was associated with greater ICU utilization and poorer outcomes. Conclusion: Acute cholangitis in this tertiary-care cohort was predominantly associated with benign biliary obstruction, particularly gallstone disease, although malignant obstruction was associated with greater severity and adverse outcomes. E. coli and Klebsiella were the predominant biliary pathogens, with substantial culture negativity. The observed antimicrobial susceptibility pattern, particularly the activity of meropenem and amikacin against several isolates, supports the importance of local microbiological surveillance and culture-guided antimicrobial therapy. Early biliary decompression, predominantly through ERCP, remains central to management.