Discussion
infections, cholangitis
INFECTIONS, CHOLANGITIS
This study developed a severity grading system to guide empiric antibacterial therapy for post-KPE cholangitis. We found that CSTS was as effective as MEPM for mild cholangitis. MEPM in combination with IVIG may be necessary in patients with severe cholangitis. We believe that severity-guided antibiotic therapy could reduce broad-spectrum antibiotic treatment for mild cholangitis and improve clinical outcomes in severe cholangitis.Treatment of post-KPE cholangitis is challenging, because the microbial causes are often unknownCefoperazone was found to be superior in the treatment of acute cholangitis, with a primary response rate of 88.9%For these reasons, it is ideal to select empirical antibiotics according to the severity of the clinical presentation. We developed a simple severity grading system to classify post-KPE cholangitis into three categories: mild, moderate, and severe. Moderate cholangitis was treated with MEPM because studies consistently showed that MEPM was an effective empirical antibiotics for post-KPE cholangitisPrevious studies have shown that IVIG supplementation in severe infections rapidly improved immune function and anti-infective capacity in childrenTo our knowledge, the severity grading system developed in the present study is the first feasible tool in the management of post-KPE cholangitis. However, our study is an open-label prospective study with a relatively small sample size. We only analyzed the outcome of the following 6 months. Long-term follow-up results should be evaluated in a future study.