Early management of severe biliary infection in the era of the Tokyo guidelines
Author
Amillo-Zaragüeta, Mireia
Juvany, Montserrat
Mourelo-Fariña, Mónica
Publication date
2023ISSN
2077-0383
Abstract
Sepsis of biliary origin is increasing worldwide and has become one of the leading causes of emergency department admissions. The presence of multi-resistant bacteria (MRB) is increasing, and mortality rates may reach 20%. This review focuses on the changes induced by the Tokyo guidelines and new concepts related to the early treatment of severe biliary disease. If cholecystitis or cholangitis is suspected, ultrasound is the imaging test of choice. Appropriate empirical antibiotic treatment should be initiated promptly, and selection should be performed while bearing in mind the severity and risk factors for MRB. In acute cholecystitis, laparoscopic cholecystectomy is the main therapeutic intervention. In patients not suitable for surgery, percutaneous cholecystostomy is a valid alternative for controlling the infection. Treatment of severe acute cholangitis is based on endoscopic or transhepatic bile duct drainage and antibiotic therapy. Endoscopic ultrasound and other new endoscopic techniques have been added to the arsenal as novel alternatives in high-risk patients. However, biliary infections remain serious conditions that can lead to sepsis and death. The introduction of internationally accepted guidelines, based on clinical presentation, laboratory tests, and imaging, provides a framework for their rapid diagnosis and treatment. Prompt assessment of patient severity, timely initiation of antimicrobials, and early control of the source of infection are essential to reduce morbidity and mortality rates.
Document Type
Article
Document version
Published version
Language
English
Subject (CDU)
61 - Medical sciences
Keywords
Infecció biliar
Colecistitis aguda
Colangitis aguda
Colecistitis acalculosa
Tractament amb antibiòtics
Vesícula biliar
Cirurgia
Revisió
Infección biliar
Colecistitis aguda
Colangitis aguda
Colecistitis alitiásica
Tratamiento con antibióticos
Vesícula biliar
Cirugía
Revisar
Biliary infection
Acute cholecystitis
Acute cholangitis
Acalculous cholecystitis
Antibiotic treatment
Gallbladder
Surgery
Review
Pages
17
Publisher
MDPI
Collection
12
Is part of
Journal of Clinical Medicine
Citation
Nve, Esther; Badia, Josep M.; Amillo-Zaragüeta, Mireia [et al.]. Early management of severe biliary infection in the era of the Tokyo guidelines. Journal of Clinical Medicine, 2023, 12(14), 4711. Disponible en: <https://www.mdpi.com/2077-0383/12/14/4711>. Fecha de acceso: 6 nov. 2023. Disponible en: <https://www.mdpi.com/2077-0383/12/14/4711>. Fecha de acceso: 6 nov 2023. DOI: doi.org/10.3390/jcm12144711
This item appears in the following Collection(s)
- Ciències de la Salut [745]
Rights
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Except where otherwise noted, this item's license is described as https://creativecommons.org/licenses/by/4.0/