{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T14:55:59Z","timestamp":1791298559535,"version":"4.1.0"},"reference-count":82,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2023,7,16]],"date-time":"2023-07-16T00:00:00Z","timestamp":1689465600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Sepsis of biliary origin is increasing worldwide and has become one of the leading causes of emergency department admissions. The presence of multi-resistant bacteria (MRB) is increasing, and mortality rates may reach 20%. This review focuses on the changes induced by the Tokyo guidelines and new concepts related to the early treatment of severe biliary disease. If cholecystitis or cholangitis is suspected, ultrasound is the imaging test of choice. Appropriate empirical antibiotic treatment should be initiated promptly, and selection should be performed while bearing in mind the severity and risk factors for MRB. In acute cholecystitis, laparoscopic cholecystectomy is the main therapeutic intervention. In patients not suitable for surgery, percutaneous cholecystostomy is a valid alternative for controlling the infection. Treatment of severe acute cholangitis is based on endoscopic or transhepatic bile duct drainage and antibiotic therapy. Endoscopic ultrasound and other new endoscopic techniques have been added to the arsenal as novel alternatives in high-risk patients. However, biliary infections remain serious conditions that can lead to sepsis and death. The introduction of internationally accepted guidelines, based on clinical presentation, laboratory tests, and imaging, provides a framework for their rapid diagnosis and treatment. Prompt assessment of patient severity, timely initiation of antimicrobials, and early control of the source of infection are essential to reduce morbidity and mortality rates.<\/jats:p>","DOI":"10.3390\/jcm12144711","type":"journal-article","created":{"date-parts":[[2023,7,17]],"date-time":"2023-07-17T00:56:47Z","timestamp":1689555407000},"page":"4711","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Early Management of Severe Biliary Infection in the Era of the Tokyo Guidelines"],"prefix":"10.3390","volume":"12","author":[{"given":"Esther","family":"Nve","sequence":"first","affiliation":[{"name":"Department of Surgery, Hospital Universitari M\u00fatua de Terrassa, 08221 Barcelona, Spain"},{"name":"School of Medicine, Universitat Rovira i Virgili, 43003 Tarragona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2928-5233","authenticated-orcid":false,"given":"Josep M.","family":"Badia","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital General Granollers, School of Medicine, Universitat Internacional de Catalunya, Av Francesc Ribas 1, 08402 Granollers, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mireia","family":"Amillo-Zarag\u00fceta","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital General Granollers, School of Medicine, Universitat Internacional de Catalunya, Av Francesc Ribas 1, 08402 Granollers, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Montserrat","family":"Juvany","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital General Granollers, School of Medicine, Universitat Internacional de Catalunya, Av Francesc Ribas 1, 08402 Granollers, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00f3nica","family":"Mourelo-Fari\u00f1a","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Complexo Hospitalario Universitario A Coru\u00f1a, 15006 A Coru\u00f1a, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3307-4340","authenticated-orcid":false,"given":"Rosa","family":"Jorba","sequence":"additional","affiliation":[{"name":"School of Medicine, Universitat Rovira i Virgili, 43003 Tarragona, Spain"},{"name":"Department of Surgery, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,16]]},"reference":[{"key":"ref_1","first-page":"1","article-title":"National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2017: Statistical Brief #261","volume":"204","author":"Liang","year":"2006","journal-title":"Healthc. 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