Acute bacterial cholangitis refers to a bacterial infection of the biliary tract. Choledocholithiasis is the most common cause of biliary obstruction, with Escherichia coli, Klebsiella spp, and Enterococcus spp the most frequent biliary pathogens isolated in patients with cholangitis. Clinical presentation varies from mild illness to septic shock. The diagnosis of cholangitis is clinical and is supported by laboratory and radiographic findings. Initial treatment is supportive and includes antibiotics to cover the typical pathogens, but definitive treatment requires biliary drainage. Endoscopic retrograde cholangiopancreatography (ERCP) is the preferred technique to achieve biliary decompression with placement of an internal or nasobiliary stent. In cases in which ERCP is unsuccessfut or technically not feasible, percutaneous transhepatic biliary drainage (PTBD) is preferred over surgery, which carries significant morbidity and mortality. In order to prevent post-ERCP cholangitis, prophylactic antibiotics are recommended in patients undergoing ERCP for known or suspected biliary obstruction.
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