Journal 2026 Vol.27 No.1
Incidence of Cholangitis and Impact of Antibiotic Prophylaxis after Kasai Portoenterostomy: A 15-Year Retrospective Study
Edan Annecia Merl D. Roa, M.D., Beverly A. Peliño, M.D.

Abstract
Objectives: This study evaluates the incidence, timing (early versus late), and clinical outcomes of post-Kasai cholangitis in a tertiary hospital over a 15-year period; the impact of oral antibiotic prophylaxis on the frequency of episodes, timing of onset, and duration of hospitalization; and to characterize the demographic, clinical, and microbiologic profiles of the cohort, including comparison of etiologic agents and antimicrobial resistance patterns between patients who received prophylaxis and those who did not.
Methodology: A retrospective cohort of 63 infants who underwent Kasai portoenterostomy (KPE) from January 2010 to March 2025 was analyzed. Demographic and clinical data, use of oral antibiotic prophylaxis (61.9%), as well as the incidence, timing, and outcomes of cholangitis and duration of hospitalization were evaluated. Associations were assessed using odds ratios (OR) with 95% confidence intervals (CI) and Fisher’s exact test.
The primary outcome was the incidence of acute cholangitis following KPE, including its overall frequency (49.2%) and the impact of antibiotic prophylaxis on reducing its occurrence. Secondary outcomes included the timing of onset (early versus late), length of hospital stay, microbiologic profile (including causative organisms and culture results), antimicrobial resistance patterns (MDR, ESBL, XDR), and the clinical and demographic characteristics of the cohort, such as gestational age, sex, and baseline liver function at the time of surgery.
Results: Cholangitis occurred in 49.2% of patients, mostly within six months post-surgery. Antibiotic prophylaxis showed no significant reduction in incidence (46.2% vs. 54.2%; OR 0.73, p = 0.62) but was associated with shorter hospital stays (<10 days: 61.1% vs. 38.5%; OR 2.51, p = 0.29). Early cholangitis (<6 months) was less frequent with prophylaxis. Culture-proven infections were rare (10.3% vs. 8.3%). One patient without prophylaxis developed fatal extensively drug-resistant Klebsiella pneumoniae infection.
Conclusion: Cholangitis remains common after KPE, particularly within six months. Although prophylaxis did not significantly lower incidence, its link to shorter hospitalization suggests reduced severity or faster recovery; however, the lack of statistical significance in the primary outcome warrants further research to strengthen such findings. The emergence of resistant pathogens highlights the need for careful antibiotic stewardship and further prospective research on optimal prophylactic strategies.

KEYWORDS: Biliary atresia, Kasai portoenterostomy, cholangitis, antibiotic prophylaxis, native liver survival
https://doi.org/10.56964/pidspj20262701004
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