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A special issue of Pathogens (ISSN 2076-0817).

Deadline for manuscript submissions: closed (15 May 2023) | Viewed by 12974

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Special Issue Editor

Dr. Vishalkumar G. Shelat

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Guest Editor

YLL School of Medicine, NUS, Kent Ridge, Singapore
Interests: hepato-pancreatico-biliary surgery; surgical infection; healthcare ethics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

For this Special Issue, we invite you to send original or review papers on clinical, imaging, microbial, cost-analysis, innovations, tele-health and public health aspects of hepatobiliary and pancreatic infections.

This Special Issue will cover the following topics:

Gallbladder: cholecystitis, empyema, percutaneous drainage, cholecystectomy;
Bile duct: cholangitis, jaundice, endoscopic biliary drainage, percutaneous biliary drainage, biliary surgery;
Liver: pyogenic liver abscess, recurrent pyogenic cholangitis, hepatolithiasis, hydatid cyst, amoebic liver abscess, parasitic liver diseases;
Viral hepatitis and its sequalae including carcinogenesis;
Pancreas necrosis and infected necrosis: imaging perspectives, endoscopic management, surgical care;
Infections and immunosuppression: liver transplantation, pancreas transplantation;
Pathogens implicated in hepatobiliary and pancreatic infections, including COVID-19 illness;
Cost-analysis, tele-health, innovations, and public health implications related to hepatobiliary and pancreatic infections;
Impact of COVID-19 on clinical care of hepatobiliary and pancreatic infections;
Any other relevant topics may be considered. We encourage authors to express their interest via pre-submission inquiry to the Guest Editor via email ([email protected]).

Lastly, the Guest Editor is interested in organizing a Delphi Consensus Guideline by forming a working group of international experts and invites interest from basic scientists, clinicians, primary and tertiary care physicians from diverse specialties. The international working group shall convene Delphi consensus on the theme of "Recurrent Pyogenic Cholangitis" and this may be compiled in the form of "International Study Group on Recurrent Pyogenic Cholangitis 2022" and could be published in this Special Issue. The Guest Editor welcomes expression of interest (via email: [email protected]) along with brief biodata and a personal statement of interest for participation as a member of the workgroup. The decision of the Guest Editor shall be final, and no appeals shall be considered.

Dr. Vishalkumar G. Shelat
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Pathogens is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

liver
gallbladder
bile duct
pancreas
sepsis
multidisciplinary
surgery
organ failure
acute care
critical care

Published Papers (6 papers)

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Research

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11 pages, 625 KiB

Open AccessArticle

Clinical Predictors for Abnormal ALT in Patients Infected with COVID-19—A Retrospective Single Centre Study

by Wei Da Chew, Jonathan Kuang, Huiyu Lin, Li Wei Ang, Wei Lyn Yang, David C. Lye and Barnaby E. Young

Pathogens 2023, 12(3), 473; https://doi.org/10.3390/pathogens12030473 - 16 Mar 2023

Viewed by 1256

Abstract

Objective: Abnormal liver tests have been associated with worse clinical outcomes in patients infected with COVID-19. This retrospective observational study from Singapore aims to elucidate simple clinical predictors of abnormal alanine aminotransferase (ALT) in COVID-19 infections. Design: 717 patients hospitalised with COVID-19 at the National Centre for Infectious Diseases (NCID), Singapore, from 23 January–15 April 2020 were screened, of which 163 patients with baseline normal alanine transferase (ALT) and at least two subsequent ALTs performed were included in the final analysis. Information on baseline demographics, clinical characteristics and biochemical laboratory tests were collected. Results: 30.7% of patients developed abnormal ALT. They were more likely to be older (60 vs. 55, p = 0.022) and have comorbidities of hyperlipidaemia and hypertension. The multivariate logistic regression showed that R-factor ≥1 on admission (adjusted odds ratio (aOR) 3.13, 95% Confidence Interval (CI) 1.41–6.95) and hypoxia (aOR 3.54, 95% CI 1.29–9.69) were independent risk factors for developing abnormal ALT. The patients who developed abnormal ALT also ran a more severe course of illness with a greater proportion needing supplementary oxygen (58% vs. 18.6%, p < 0.0005), admission to the Intensive Care Unit (ICU)/High Dependency Unit (HDU) (32% vs. 11.5%, p = 0.003) and intubation (20% vs. 2.7%, p < 0.0005). There was no difference in death rate between the two groups. Conclusions: Liver injury is associated with poor clinical outcomes in patients with COVID-19. R-factor ≥1 on admission and hypoxia are independent simple clinical predictors for developing abnormal ALT in COVID-19. Full article

(This article belongs to the Special Issue Hepatobiliary and Pancreatic Infections)

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14 pages, 7733 KiB

Open AccessArticle

Surgical Site Infections in Patients of Periampullary Carcinoma Undergoing Delayed Bile Duct Division (COMBILAST) in Whipple’s Procedure: A Prospective Cohort Study

by Prakash Kumar Sasmal, Kallol Kumar Das Poddar, Tushar Subhadarshan Mishra and Pankaj Kumar

Pathogens 2023, 12(3), 448; https://doi.org/10.3390/pathogens12030448 - 13 Mar 2023

Viewed by 2531

Abstract

Surgical site infections (SSIs) following a pancreaticoduodenectomy have been a significant cause of morbidity and even mortality. A modified sequence of the Whipple procedure, using the COMBILAST technique, may reduce SSIs and the patient’s hospital stay. This prospective cohort study included 42 patients undergoing Whipple’s pancreaticoduodenectomy for a periampullary malignancy. The modified sequence pancreaticoduodenectomy technique, COMBILAST, was used to estimate the incidence of SSI and explore other advantages. Of the 42 patients, seven (16.7%) developed superficial SSIs, and two patients (4.8%) had an additional deep SSI. Positive intraoperative bile culture had the strongest association with SSI (OR: 20.25, 95% CI: 2.12, 193.91). The mean operative duration was 391.28 ± 67.86 min, and the mean blood loss was 705 ± 172 mL. A total of fourteen (33.3%) patients had a Clavien–Dindo grade of III or higher. Three (7.1%) patients died of septicemia. The average length of a hospital stay was 13.00 ± 5.92 days. A modified sequence of the Whipple procedure, using the COMBILAST technique, seems promising in reducing SSIs and the patient’s hospital stay. As the approach is only a modification of the operative sequence, it does not compromise the oncological safety of the patient. Moreover, it has an added surgical advantage in reducing the chance of injury to the aberrant or accessory right hepatic artery. Full article

(This article belongs to the Special Issue Hepatobiliary and Pancreatic Infections)

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15 pages, 2919 KiB

Open AccessArticle

Pancreatic Necrosis Infection as a Determinant of Multiple Organ Failure and Mortality in Acute Pancreatitis

by Igor A. Kryvoruchko, Valeriy V. Boyko, Massimo Sartelli, Yulia V. Ivanova, Denys O. Yevtushenko and Andrij S. Honcharov

Pathogens 2023, 12(3), 428; https://doi.org/10.3390/pathogens12030428 - 08 Mar 2023

Cited by 2 | Viewed by 1531

Abstract

Several recommendations and data on the treatment of acute necrotizing pancreatitis (ANP) are conflicting and different surgical approaches continue to exist. We conducted a study on 148 patients with ANP, who were divided into two groups: the main group (n = 95) when the tactics of the step-up approach were applied with the principles of the concept of Enhanced Recovery After Surgery (ERAS) in order to determine this approach on effectiveness in reducing complications and 30-day mortality (2017–2022); the comparison group (n = 53) when the same tactic of the treatment was used without ERAS principles (2015–2016). Treatment time for the main group in the intensive care unit was minimized (p ≤ 0.004); it has been shown to reduce the frequency of complications in these patients (p < 0.001) requiring conservative or surgical treatment without general anaesthesia (Clavien-Dindo I-IIIa); no statistically significant differences were observed for the total incidence of Clavien-Dindo IIIb-IVb complications (p > 0.05); the median duration of treatment for patients in the primary group was 23 days, and in the reference group—34 days (p ≤ 0.003). Pancreatic infections have been observed in 92 (62.2%) patients and gram-negative bacteria predominated in the overall pathogen structure with 222 (70.7%) strains. The only evidence of multiple organ failure before (AUC = 0.814) and after surgery (AUC = 0.931) was found to be predictive of mortality. Antibiotic sensitivity of all isolated bacteria better understood local epidemiology and identified the most effective antibiotics when treating patients. Full article

(This article belongs to the Special Issue Hepatobiliary and Pancreatic Infections)

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Review

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16 pages, 1013 KiB

Open AccessEditor’s ChoiceReview

Opisthorchis viverrini—Current Understanding of the Neglected Hepatobiliary Parasite

by Matthias Yi Quan Liau, En Qi Toh and Vishalkumar Girishchandra Shelat

Pathogens 2023, 12(6), 795; https://doi.org/10.3390/pathogens12060795 - 02 Jun 2023

Cited by 6 | Viewed by 2090

Abstract

Opisthorchiasis due to Opisthorchis viverrini infection continues to be a significant public healthcare concern in various subregions of Southeast Asia, particularly in Thailand, Laos, Cambodia, Myanmar, and Vietnam. The main mode of transmission is via consumption of raw or undercooked fish, which is deeply embedded in the culture and tradition of the people living near the Mekong River. After ingestion, the flukes migrate to the bile ducts, potentially causing many hepatobiliary complications, including cholangitis, cholecystitis, cholelithiasis, advanced periductal fibrosis and cholangiocarcinoma. Several mechanisms of opisthorchiasis-associated cholangiocarcinogenesis have been proposed and elucidated in the past decade, providing insight and potential drug targets to prevent the development of the sinister complication. The gold standard for diagnosing opisthorchiasis is still via stool microscopy, but the advent of novel serological, antigen, and molecular tests shows promise as more convenient, alternative diagnostic methods. The mainstay of treatment of opisthorchiasis is praziquantel, while treatment of opisthorchiasis-associated cholangiocarcinoma depends on its anatomic subtype and resectability. Thus far, the most successful fluke control programme is the Lawa model based in Thailand, which raised awareness, incorporated education, and frequent surveillance of intermediate hosts to reduce transmission of opisthorchiasis. Development of vaccines using tetraspanins shows promise and is currently ongoing. Full article

(This article belongs to the Special Issue Hepatobiliary and Pancreatic Infections)

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Other

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8 pages, 986 KiB

Open AccessCase Report

Biliary Sepsis Due to Recurrent Acute Calculus Cholecystitis (ACC) in a High Surgical-Risk Elderly Patient: An Unexpected Complication

by Giacomo Sermonesi, Alessia Rampini, Girolamo Convertini, Raffaele Bova, Nicola Zanini, Riccardo Bertelli, Carlo Vallicelli, Francesco Favi, Giacomo Stacchini, Enrico Faccani, Nicola Fabbri and Fausto Catena

Pathogens 2022, 11(12), 1423; https://doi.org/10.3390/pathogens11121423 - 26 Nov 2022

Cited by 1 | Viewed by 2470

Abstract

Acute calculus cholecystitis (ACC) is increasing in frequency within an ageing population, in which biliary tract infection, including cholecystitis and cholangitis, is the second most common cause of sepsis, with higher morbidity and mortality rates. Patient’s critical conditions, such as septic shock or anaesthesiology contraindication, may be reasons to avoid laparoscopic cholecystectomy—the first-line treatment of ACC—preferring gallbladder drainage. It can aid in patient’s stabilization with also the benefit of identifying the causative organism to establish a targeted antibiotic therapy, especially in patients at high risk for antimicrobial resistance such as healthcare-associated infection. Nevertheless, a recent randomized clinical trial showed that laparoscopic cholecystectomy can reduce the rate of major complications compared with percutaneous catheter drainage in critically ill patients too. On the other hand, among the possibilities to control biliary sepsis in non-operative management of ACC, according to recent meta-analysis, endoscopic gallbladder drainage showed better clinical success rate, and it is gaining popularity because of the potential advantage of allowing gallstones clearance to reduce recurrences of ACC. However, complications that may arise, although rare, can worsen an already weak clinical condition, as happened to the high surgical-risk elderly patient taken into account in our case report. Full article

(This article belongs to the Special Issue Hepatobiliary and Pancreatic Infections)

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15 pages, 1034 KiB

Open AccessSystematic Review

Demographics, Radiological Findings, and Clinical Outcomes of Klebsiella pneumonia vs. Non-Klebsiella pneumoniae Pyogenic Liver Abscess: A Systematic Review and Meta-Analysis with Trial Sequential Analysis

by Kai Siang Chan, Christopher Tze Wei Chia and Vishal G. Shelat

Pathogens 2022, 11(9), 976; https://doi.org/10.3390/pathogens11090976 - 26 Aug 2022

Cited by 14 | Viewed by 2008

Abstract

Pyogenic liver abscess (PLA) is a common cause of hepatobiliary sepsis. Klebsiella pneumoniae (KP) is the most common organism causing PLA. Evidence is scarce on the demographics, radiological findings, and outcomes of KPPLA versus non-KPPLA (N-KPPLA). PubMed, Embase, The Cochrane Library, and Scopus were systematically searched until 14 May 2022 for studies comparing KPPLA and N-KPPLA. Exclusion criteria were single-arm studies. Primary outcomes were mortality (30-day/in-hospital) and metastatic complications. There were 16 studies, including 5127 patients (KPPLA n = 3305, N-KPPLA n = 1822). Patients with KPPLA were younger (mean difference: −2.04 years, p = 0.02). History of hepatobiliary disease (Odds ratio (OR) 0.30, 95% CI: 0.20, 0.46) and malignancy (OR 0.26, 95% CI: 0.16, 0.42) were less common in KPPLA. KPPLA was associated with lower incidence of multiple abscesses (OR 0.52, 95% CI: 0.35, 0.76, p < 0.001) and bilobar abscesses (OR 0.60, 95% CI: 0.49, 0.74, p < 0.001). KPPLA has higher overall metastatic complications (KPPLA 9.7% vs. N-KPPLA 4.8%, OR 3.16, 95% CI: 2.00, 4.99, p < 0.001), but lower mortality (KPPLA 3.9% vs. N-KPPLA 7.6%, OR 0.51, 95% CI: 0.34, 0.78, p < 0.001). Trial sequential analysis showed conclusive evidence that KPPLA has lower mortality than N-KPPLA. In conclusion, KPPLA has lower mortality than N-KPPLA. Full article

(This article belongs to the Special Issue Hepatobiliary and Pancreatic Infections)

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