Does the identity of the bacteria matter in post-Kasai cholangitis? A comparison between simple and intractable cholangitis

Abstract

Background: The objective of this study is to identify and compare the microbiology and clinical outcomes between simple and intractable cholangitis after Kasai operation. Materials and methods: A retrospective study was carried out for all post-Kasai patients (n=192) treated in our centre from 1980 to 2015. Simple (SC) and intractable cholangitis (IC) were classified according to the duration of intravenous antibiotics required ( Results: The mean follow up duration was 135+/-31.6 months. Sixty-eight patients have developed post-Kasai cholangitis and 16 cases were considered intractable. Apparently, more patients in the IC group had a positive blood culture (43.8% vs 26.9%, p = 0.072). The most common bacteria identified in IC and SC groups were Staphylococcus aureus and Escherichia Coli respectively. More patients the IC group required the change of antibiotics (50% vs 76.9%, p = 0.49) as well as a longer duration of usage (42.3 +/- 11.1 days vs 18.5 +/- 6.9 days, p = 0.001). Until the latest follow up, the native liver survival in IC and SC was 50.0% and 75.0% (p = 0.07) respectively. Conclusion: Blood culture should be taken prior to antibiotics treatment in post-Kasai cholangitis to identify the organism. Infection with Staphylococcus aureus should be treated aggressively to prevent the development of intractable cholangitis which is associated with a lower long term native liver survival.