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Predicting Infected Bile Among Patients Undergoing Percutaneous Cholecystostomy

  • Clinical Investigation
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Abstract

Purpose

Patients may not achieve a clinical benefit after percutaneous cholecystostomy due to the inherent difficulty in identifying patients who truly have infected gallbladders. We attempted to identify imaging and biochemical parameters which would help to predict which patients have infected gallbladders.

Methods

A retrospective review was performed of 52 patients undergoing percutaneous cholecystostomy for clinical suspicion of acute cholecystitis in whom bile culture results were available. Multiple imaging and biochemical variables were examined alone and in combination as predictors of infected bile, using logistic regression.

Results

Of the 52 patients, 25 (48%) had infected bile. Organisms cultured included Enterococcus, Enterobacter, Klebsiella, Pseudomonas, E. coli, Citrobacter and Candida. No biochemical parameters were significantly predictive of infected bile; white blood cell count >15,000 was weakly associated with greater odds of infected bile (odds ratio 2.0, p = NS). The presence of gallstones, sludge, gallbladder wall thickening and pericholecystic fluid by ultrasound or CT were not predictive of infected bile, alone or in combination, although a trend was observed among patients with CT findings of acute cholecystitis toward a higher 30-day mortality. Radionuclide scans were performed in 31% of patients; all were positive and 66% of these patients had infected bile. Since no patient who underwent a radionuclide scan had a negative study, this variable could not be entered into the regression model due to collinearity.

Conclusion

No single CT or ultrasound imaging variable was predictive of infected bile, and only a weak association of white blood cell count with infected bile was seen. No other biochemical parameters had any association with infected bile. The ability of radionuclide scanning to predict infected bile was higher than that of ultrasound or CT. This study illustrates the continued challenge to identify bact-erial cholecystitis among patients referred for percutaneous cholecystostomy.

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References

  1. H Overhagen ParticleVan H Meyers HW Tilanus et al. (1996) ArticleTitlePercutaneous cholecystostomy for patients with acute cholecystitis and an increased surgical risk Cardiovasc Intervent Radiol 19 72–76 Occurrence Handle10.1007/s002709900017 Occurrence Handle8662161

    Article  PubMed  Google Scholar 

  2. GW Boland MJ Lee J Leung et al. (1994) ArticleTitlePercutaneous cholecystostomy in critically ill patients: Early response and final outcome in 82 patients AJR Am J Roentgenol 163 339–342 Occurrence Handle1:STN:280:ByuA3M7htFE%3D Occurrence Handle8037026

    CAS  PubMed  Google Scholar 

  3. JP McGahan KK Lindfors (1988) ArticleTitleAcute cholecystitis: Diagnostic accuracy of percutaneous aspiration of the gallbladder Radiology 167 669–671

    Google Scholar 

  4. AM Farinon M Grande A Torquati et al. (1993) ArticleTitleMultivariate analysis for predicting the presence of bacteria in bile in patients with acute cholecystitis Eur J Surg 159 531–534 Occurrence Handle1:STN:280:ByuC3Mvmslc%3D Occurrence Handle8286510

    CAS  PubMed  Google Scholar 

  5. Y Shirae K Tsukada H Kawaguchi et al. (1993) ArticleTitlePercutaneous transhepatic cholecystostomy for acute acalculous cholecystitis Br J Surg 80 1440–1442 Occurrence Handle8252358

    PubMed  Google Scholar 

  6. DL Nahrwold (1997) Chronic cholecystitis and cholelithiasis DC Sabiston SuffixJr (Eds) Textbook of surgery WB Saunders Philadelphia

    Google Scholar 

  7. KW Sharp (1988) Acute cholecystitis JL Sawyers LF Williams (Eds) Acute abdomen, vol 68 WB Saunders Philadelphia 269–279

    Google Scholar 

  8. BM Evers CM Townsend SuffixJr JC Thompson (1994) ArticleTitleOrgan physiology of aging Surg Clin North Am 74 23–29 Occurrence Handle1:STN:280:ByuC2M7nt1c%3D Occurrence Handle8108769

    CAS  PubMed  Google Scholar 

  9. R Reiss AA Deutsch (1993) ArticleTitleState of the art in the diagnosis and management of acute cholecystitis Dig Dis 11 55–64 Occurrence Handle1:STN:280:ByyC1crivVc%3D Occurrence Handle8443956

    CAS  PubMed  Google Scholar 

  10. S Schwartz G Shires F Spencer (1989) Gallbladder and extrahepatic biliary system S Schwartz (Eds) Principles of surgery EditionNumber5th edn McGraw-Hill New York 1395–1398

    Google Scholar 

  11. JN Vauthey J Lerut M Martini (1993) ArticleTitleIndications and limitations of percutaneous cholecystostomy for acute cholecystitis Surg Gynecol Obstet 176 49–54 Occurrence Handle1:STN:280:ByyC2M%2FksFU%3D Occurrence Handle8427004

    CAS  PubMed  Google Scholar 

  12. SJ Margiotta SuffixJr JH Willis MK Wallack (1988) ArticleTitleCholecystectomy in the elderly Am Surg 54 34–39 Occurrence Handle3337481

    PubMed  Google Scholar 

  13. A Hafif M Gutman O Kaplan et al. (1991) ArticleTitleThe management of acute cholecystitis in the elderly patient Am Surg 57 648–652 Occurrence Handle1:STN:280:By2D38jhvVc%3D Occurrence Handle1928982

    CAS  PubMed  Google Scholar 

  14. G Edlund M Ljungdahl (1990) ArticleTitleAcute cholecystitis in the elderly Am J Surg 159 414–416 Occurrence Handle1:STN:280:By%2BC1MnkvVc%3D Occurrence Handle2180337

    CAS  PubMed  Google Scholar 

  15. J Prousalidis E Fahadidis S Apostolidis et al. (1996) ArticleTitleAcute cholecystitis in aged patients HBP Surg 9 129–131 Occurrence Handle1:STN:280:BymA3c7ntVQ%3D

    CAS  Google Scholar 

  16. RW Radder (1980) ArticleTitleUltrasonically guided percutaneous catheter drainage for gallbladder edema Diagn Imaging 49 330–333 Occurrence Handle1:STN:280:Bi6C28zpslU%3D Occurrence Handle7215096

    CAS  PubMed  Google Scholar 

  17. L Chang R Moonka M Stelzner (2000) ArticleTitlePercutaneous cholecystostomy for acute cholecystitis in veteran patients Am J Surg 180 198–202 Occurrence Handle10.1016/S0002-9610(00)00476-1 Occurrence Handle1:STN:280:DC%2BD3M%2FmtFOitA%3D%3D Occurrence Handle11084129

    Article  CAS  PubMed  Google Scholar 

  18. H Vingan (1995) ArticleTitleDon’t forget cholecystostomy in the era of ERCP and laparoscopic cholecystectomy Am J Gastroenterol 90 669–670 Occurrence Handle1:STN:280:ByqB3szjslU%3D Occurrence Handle7717339

    CAS  PubMed  Google Scholar 

  19. N Allmendinger MJ Hallisey SK Ohki et al. (1995) ArticleTitlePercutaneous cholecystostomy treatment of acute cholecystitis in pregnancy Obstet Gynecol 86 653–654 Occurrence Handle10.1016/0029-7844(95)00087-8 Occurrence Handle1:STN:280:ByqH3crotVE%3D Occurrence Handle7675401

    Article  CAS  PubMed  Google Scholar 

  20. R Avrahami E Badani S Watemberg et al. (1995) ArticleTitleThe role of percutaneous transhepatic cholecystostomy in the management of acute cholecystitis in high-risk patients Int Surg 80 111–114 Occurrence Handle1:STN:280:BymD1MfkvFI%3D Occurrence Handle8530223

    CAS  PubMed  Google Scholar 

  21. RL Sheridan CM Ryan MJ Lee et al. (1995) ArticleTitlePercutaneous cholecystostomy in the critically ill burn patient J Trauma 38 248–251 Occurrence Handle1:STN:280:ByqC2svgsVY%3D Occurrence Handle7869446

    CAS  PubMed  Google Scholar 

  22. EJ Patterson RF McLoughlin JR Mathieson et al. (1996) ArticleTitleAn alternative approach to acute cholecystitis: Percutaneous cholecystostomy and interval laparoscopic cholecystectomy Surg Endosc 10 1185– 1188 Occurrence Handle10.1007/s004649900275 Occurrence Handle1:STN:280:ByiC2srotlA%3D Occurrence Handle8939839

    Article  CAS  PubMed  Google Scholar 

  23. U Boggi G DiCandio A Campatelli (1999) ArticleTitlePercutaneous cholecystostomy for acute cholecystitis in critically ill patients Hepatogastroenterology 46 121–125 Occurrence Handle1:STN:280:DyaK1M3ksFCmuw%3D%3D Occurrence Handle10228775

    CAS  PubMed  Google Scholar 

  24. RC Frazee DM Nagorney P Mucha SuffixJr (1989) ArticleTitleAcute acalculous cholecystitis Mayo Clin Proc 64 163–167 Occurrence Handle1:STN:280:BiaC2MfivVw%3D Occurrence Handle2921875

    CAS  PubMed  Google Scholar 

  25. PS Barie E Fischer (1995) ArticleTitleAcute calculous cholecystitis J Am Coll Surg 180 232–243 Occurrence Handle1:STN:280:ByqC2M3ptVE%3D Occurrence Handle7850064

    CAS  PubMed  Google Scholar 

  26. LW Ottinger (1976) ArticleTitleAcute cholecystitis as a postoperative complication Ann Surg 184 162–165 Occurrence Handle1:STN:280:CSmB2M7nvFI%3D Occurrence Handle952563

    CAS  PubMed  Google Scholar 

  27. DL Nahrwold (1991) Acute cholecystitis DC Sabiston SuffixJr (Eds) Textbook of surgery WB Saunders Philadelphia 1050–1052

    Google Scholar 

  28. MJ Zinner JJ Roslyn (1994) Gallbladder and extrahepatobiliary system SI Schwartz GT Shires FC Spencer (Eds) Principles of surgery McGraw-Hill New York 1379–1380

    Google Scholar 

  29. M Sianesi A Ghirarduzzi M Percudani et al. (1984) ArticleTitleCholecystectomy for acute cholecystitis: Timing of operation, bacteriologic aspects and postoperative course Am J Surg 148 609–612 Occurrence Handle10.1016/0002-9610(84)90334-9 Occurrence Handle1:STN:280:BiqD2cvltVI%3D Occurrence Handle6496850

    Article  CAS  PubMed  Google Scholar 

  30. RJ Howard (1981) ArticleTitleAcute acalculous cholecystitis Am J Surg 141 194–198 Occurrence Handle10.1016/0002-9610(81)90155-0 Occurrence Handle1:STN:280:Bi6C3cjhsVc%3D Occurrence Handle7457736

    Article  CAS  PubMed  Google Scholar 

  31. TL Hwang MJ Chen (1992) ArticleTitlePercutaneous gallbladder drainage for acute acalculous cholecystitis during total parenteral nutrition Br J Surg 79 237–238 Occurrence Handle1:STN:280:By2B3cfntFw%3D Occurrence Handle1555090

    CAS  PubMed  Google Scholar 

  32. JC Coelho AC Campos M Moreira et al. (1991) ArticleTitleAcute acalculous cholecystitis Int Surg 76 146–148 Occurrence Handle1:STN:280:By2D2c%2FmslI%3D Occurrence Handle1938201

    CAS  PubMed  Google Scholar 

  33. AM Eggermont JS Lameris J Jeekel (1984) ArticleTitleUltrasound-guided percutaneous transhepatic cholecystosotmy for acute acalculous cholecystitis Arch Surg 120 1354–1356

    Google Scholar 

  34. CG Becker T Dubin F Glenn (1980) ArticleTitleInduction of acute cholecystitis by activation of Factor XII J Exp Med 151 81–90 Occurrence Handle10.1084/jem.151.1.81 Occurrence Handle1:CAS:528:DyaL3cXpt1alsg%3D%3D Occurrence Handle6765972

    Article  CAS  PubMed  Google Scholar 

  35. F Glenn CG Becker (1982) ArticleTitleAcute acalculous cholecystitis: An increasing entitiy Ann Surg 195 131–136 Occurrence Handle1:STN:280:Bi2C3M3jsFc%3D Occurrence Handle7055388

    CAS  PubMed  Google Scholar 

  36. BL Warren (1992) ArticleTitleSmall vessel occlusion in acute acalculous cholecystitis Surgery 111 163–168 Occurrence Handle1:STN:280:By2C2c7ptFQ%3D Occurrence Handle1736386

    CAS  PubMed  Google Scholar 

  37. EJ Patterson RF McLoughlin JR Mathieson et al. (1996) ArticleTitleAn alternative approach to acute cholecystitis Surg Endosc 10 1185–1188 Occurrence Handle10.1007/s004649900275 Occurrence Handle1:STN:280:ByiC2srotlA%3D Occurrence Handle8939839

    Article  CAS  PubMed  Google Scholar 

  38. G Borzellino G Manzoni ParticleDe F Ricci et al. (1999) ArticleTitleEmergency cholecystostomy and subsequent cholecystectomy for acute gallstone cholecystitis in the elderly Br J Surg 86 1521–1525 Occurrence Handle10.1046/j.1365-2168.1999.01284.x Occurrence Handle1:STN:280:DC%2BD3c%2Fmt1Chsw%3D%3D Occurrence Handle10594498

    Article  CAS  PubMed  Google Scholar 

  39. FC Laing MP Fenerle RB Jeffrey et al. (1981) ArticleTitleUltrasonic evaluation of patients with acute right upper quadrant pain Radiology 140 449–455 Occurrence Handle1:STN:280:Bi6B2cjpvFY%3D Occurrence Handle7255722

    CAS  PubMed  Google Scholar 

  40. RK Zeman MI Burrell CE Cahow et al. (1981) ArticleTitleDiagnostic utility of cholescintigraphy and ultrasonography in acute cholecystitis Am J Surg 141 446–451 Occurrence Handle10.1016/0002-9610(81)90138-0 Occurrence Handle1:STN:280:Bi6C1c7ltlU%3D Occurrence Handle7223932

    Article  CAS  PubMed  Google Scholar 

  41. JE Thompson RS Bennion JE Doty et al. (1990) ArticleTitlePredictive factors for bactibilia in acute cholecystitis Arch Surg 125 261–264 Occurrence Handle2302066

    PubMed  Google Scholar 

  42. PJ Gruber RA Silverman S Gottesfeld et al. (1996) ArticleTitlePresence of fever and leukocytosis in acute cholecystitis Ann Emerg Med 28 273–277 Occurrence Handle1:STN:280:BymA2svhslw%3D Occurrence Handle8780469

    CAS  PubMed  Google Scholar 

  43. AM Raine AA Gunn (1975) ArticleTitleAcute cholecystitis Br J Surg 62 697– 700 Occurrence Handle1:STN:280:CSmD3Mbot1w%3D Occurrence Handle1174813

    CAS  PubMed  Google Scholar 

  44. PW Ralls PM Colletti JM Halls et al. (1982) ArticleTitleProspective evaluation of 99m-Tc-IDA cholescintigraphy and gray-scale ultrasound in the diagnosis of acute cholecystitis Radiology 144 369–371

    Google Scholar 

  45. I Cintora A Ben-Ora R MacNeil et al. (1979) ArticleTitleCholecystosonography for the decision to operate when acute cholecystitis is suspected Am J Surg 138 818–820 Occurrence Handle10.1016/0002-9610(79)90303-9 Occurrence Handle1:STN:280:Bi%2BD283os1I%3D Occurrence Handle507298

    Article  CAS  PubMed  Google Scholar 

  46. PJ Dempsey JF Phillips DL Warren et al. (1978) ArticleTitleCholecystosonography for the diagnosis of cholecystolithiasis Ann Surg 187 465–474 Occurrence Handle1:STN:280:CSeC28vptlE%3D Occurrence Handle206215

    CAS  PubMed  Google Scholar 

  47. WA Fajman (1983) ArticleTitleAcute right upper quadrant abdominal pain: Radionuclide approach J Clin Ultrasound 11 193–200 Occurrence Handle1:STN:280:BiyB3sbgtlQ%3D Occurrence Handle6408128

    CAS  PubMed  Google Scholar 

  48. MW Mattson JM Sterchi RJ Myers (1981) ArticleTitleAccuracy of ultrasonography and oral cholecystography in the diagnosis of cholelithiasis Am Surg 47 80–81 Occurrence Handle1:STN:280:Bi6C3s7otFY%3D Occurrence Handle7469184

    CAS  PubMed  Google Scholar 

  49. ER Thal J Weigelt M Landay et al. (1978) ArticleTitleEvaluation of ultrasound in the diagnosis of acute and chronic biliary tract disease Arch Surg 113 500–503 Occurrence Handle1:STN:280:CSeC2czos1I%3D Occurrence Handle637721

    CAS  PubMed  Google Scholar 

  50. GW Boland G Slater D Lu et al. (2000) ArticleTitlePrevalence and significance of gallbladder abnormalities seen on sonography in intensive care unit patients AJR Am J Roentgenol 174 973–977 Occurrence Handle1:STN:280:DC%2BD3c3htVOqsg%3D%3D Occurrence Handle10749232

    CAS  PubMed  Google Scholar 

  51. V Kalff JW Froelich R Lloyd et al. (1983) ArticleTitlePredictive value of an abnormal hepatobiliary scan in patients with severe intercurrent illness Radiology 146 191–194

    Google Scholar 

  52. HS Weissmann MS Frank LH Bernstein et al. (1979) ArticleTitleRapid and accurate diagnosis of acute cholecystitis with 99m-Tc-HIDA cholescintigraphy AJR Am J Roentgenol 132 523–528 Occurrence Handle1:STN:280:CSaC2c3hslw%3D Occurrence Handle106679

    CAS  PubMed  Google Scholar 

  53. D Choy EC Shi RG McLean et al. (1984) ArticleTitleCholescintigraphy in acute cholecystitis: Use of intravenous morphine Radiology 151 203–207

    Google Scholar 

  54. RE England VG McDermott TP Smith et al. (1997) ArticleTitlePercutaneous cholecystostomy: who responds? AJR Am J Roentgenol 168 1247–1251 Occurrence Handle1:STN:280:ByiB2srmsFU%3D Occurrence Handle9129421

    CAS  PubMed  Google Scholar 

  55. B Brismar K Jalakas AS Malmborg et al. (1986) ArticleTitleThe significance of bacteriological findings at cholecystectomy Acta Chir Scand Suppl 530 35–38 Occurrence Handle1:STN:280:BimB28vjtVc%3D Occurrence Handle3460289

    CAS  PubMed  Google Scholar 

  56. L Chang R Moonka M Stelzner (2000) ArticleTitlePercutaneous cholecystostomy for acute cholecystitis in veteran patients Am J Surg 180 198–202 Occurrence Handle10.1016/S0002-9610(00)00476-1 Occurrence Handle1:STN:280:DC%2BD3M%2FmtFOitA%3D%3D Occurrence Handle11084129

    Article  CAS  PubMed  Google Scholar 

  57. P Janowitz JG Wechsler J Tudyka et al. (1993) ArticleTitleThe incidence of bactibilia in gallstone patients without evidence of chronic or acute cholecystitis Am J Gastroenterol 88 614–615 Occurrence Handle1:STN:280:ByyB38fgsV0%3D Occurrence Handle8470654

    CAS  PubMed  Google Scholar 

  58. B Claesson D Holmlung T Matzsch (1986) ArticleTitleMicroflora of the gallbladder related to duration of acute cholecystitis Surg Gynecol Obstet 162 531–535 Occurrence Handle1:STN:280:BimB3srpslA%3D Occurrence Handle3715685

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Section of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Shannon L. Beardsley, Richard D. Shlansky-Goldberg, Aalpen Patel, David B. Freiman, Michael C. Soulen, S. William Stavropoulos & Timothy W.I. Clark

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  1. Shannon L. Beardsley
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  2. Richard D. Shlansky-Goldberg
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  3. Aalpen Patel
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  4. David B. Freiman
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  7. Timothy W.I. Clark
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Correspondence to Timothy W.I. Clark.

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Beardsley, S.L., Shlansky-Goldberg, R.D., Patel, A. et al. Predicting Infected Bile Among Patients Undergoing Percutaneous Cholecystostomy. Cardiovasc Intervent Radiol 28, 319–325 (2005). https://doi.org/10.1007/s00270-003-0260-1

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