Analysis of Pathogenic Bacteria Distribution and Related Factors in Recurrent Acute Cholangitis

BACKGROUND: To evaluate the risk factors and prognosis of patients with acute cholangitis recurrence. METHODS: A total of 503 patients with acute cholangitis admitted to the First Affiliated Hospital of Chongqing Medical University between July 2013 and January 2022 were included in this retrospective observational study, who were followed up for 360 days and divided into relapse group and non-recurrence group according to the recurrence of acute cholangitis. Risk factors and prognosis of patients with acute cholangitis recurrence were analyzed by univariate, multivariate analyses and proportional hazards model. RESULTS: A total of 161 patients with recurrent acute cholangitis were identified. Recurrent acute cholangitis usually occurred within 125 days; Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis, and Enterococcus faecium was the most common positive record both in blood and bile culture. In the multivariate analysis, abdominal pain (OR = 2.448, 95% CI = 1.196–5.010, P = 0.014), bile stones (OR = 2.429, 95% CI = 1.024–5.762, P = 0.044), diabetes (OR = 1.790, 95% CI = 1.007–3.182, P = 0.047), pathogen (OR = 3.305, 95% CI = 1.932–5.654, P<0.001), and chronic kidney disease (OR = 2.500, 95% CI = 1.197–5.221, P = 0.015) may be ascertained as the risk factors of acute cholangitis recurrence. The recurrence of acute cholangitis was identified as an independent risk factor for patient death (HR = 4.524, 95% CI = 1.426–14.357, P = 0.010) by Cox proportional-hazards regression. CONCLUSION: Abdominal pain, bile stones, diabetes and chronic kidney disease may be risk factors of acute cholangitis recurrence. Patients with recurrent acute cholangitis have poor prognosis and high mortality. Early control of recurrent risk factors and active intervention are beneficial to high-risk patients.