Overview
Infection of biliary stents, often referred to as stent-related biliary infections, involves microbial contamination within or around the stent, potentially leading to complications such as cholangitis, abscess formation, and bacteremia. 1Diagnosis
Clinical Presentation: Fever, abdominal pain, jaundice, and signs of systemic inflammatory response syndrome (SIRS).
Laboratory Tests: Elevated white blood cell count, liver function tests abnormalities, and blood cultures to identify bacteremia.
Imaging: Abdominal ultrasound or CT scan to assess for biliary dilation, abscesses, or signs of obstruction.
Microbiological Confirmation: Bile cultures and stent aspiration to identify causative organisms.
Grading Severity: Classification into none, systemic inflammatory response syndrome (SIRS), severe (abscess, cholangitis, empyema), or multi-organ dysfunction syndrome based on clinical and laboratory findings. 1Management
Antibiotics: Broad-spectrum coverage initially, tailored based on culture and sensitivity results. Specific drug classes include beta-lactams, fluoroquinolones, or carbapenems depending on local resistance patterns.
Stent Removal: Consider removal of infected stent if feasible and safe, often guided by clinical response and imaging.
Supportive Care: Fluid resuscitation, management of organ dysfunction, and close monitoring in severe cases.
Source Control: Address underlying biliary obstruction and manage any abscesses surgically or percutaneously.Special Populations
Obesity: Lower BMI inversely correlates with more severe biliary infections, suggesting obese patients may experience less severe infections. This may influence management strategies and monitoring intensity. 1Key Recommendations
Monitor BMI in Patients: Consider lower BMI as a potential marker for more severe biliary infections, warranting closer monitoring and possibly more aggressive initial management. (Evidence: Moderate) 1
Tailored Antibiotic Therapy: Initiate broad-spectrum antibiotics and adjust based on culture results to ensure effective coverage against identified pathogens. (Evidence: Expert opinion)
Evaluate for Stent Removal: Assess the feasibility and necessity of stent removal in cases of confirmed infection, balancing clinical improvement with procedural risks. (Evidence: Moderate)References
1 Stewart L, Griffiss JM, Jarvis GA, Way LW. The association between body mass index and severe biliary infections: a multivariate analysis. American journal of surgery 2012. link