Shunsuke Uno1, Ryota Hase2, Masayoshi Kobayashi3, Toshiyasu Shiratori3, So Nakaji3, Nobuto Hirata3, Naoto Hosokawa2. 1. Center for Infectious Diseases and Infection Control, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan. Electronic address: br.op45@gmail.com. 2. Department of Infectious Diseases, Kameda Medical Center, Kamogawa, Chiba, Japan. 3. Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan.
Abstract
OBJECTIVES: The optimal antimicrobial treatment duration for patients with acute cholangitis with bacteremia remains unknown. The updated Tokyo Guidelines 2013 recommend a minimum duration of 2 weeks only when bacteremia with Gram-positive cocci is present. Since May 2013, a shorter antimicrobial treatment duration of under 2 weeks has been implemented at the authors' institution for acute cholangitis with Gram-negative bacillary bacteremia. The aim of the present study was to validate this modified practice. METHODS: A single-center retrospective cohort study was conducted. The antimicrobial treatment duration, 30-day mortality rate, and recurrence rate within 3 months were compared between patients treated before May 2013 and after May 2013. RESULTS: Ninety-one patients with cholangitis with bacteremia were analyzed. The median antimicrobial treatment duration was 14.5days in patients treated before May 2013 and 10.0days after May 2013 (p <0.001). While the 30-day mortality rate did not differ significantly, the recurrence rate was higher in those treated before May 2013 (5.7% vs. 0.0%, p=0.17 and 13.3% vs. 0.0%, p=0.03, respectively). The median treatment duration after May 2013 was 8days for grade I patients, 10days for grade II patients, and 11.5days for grade III patients. CONCLUSIONS: The results of this study suggest that acute cholangitis with Gram-negative bacillary bacteremia can be treated safely with a shorter antimicrobial treatment duration of <14 days.
OBJECTIVES: The optimal antimicrobial treatment duration for patients with acute cholangitis with bacteremia remains unknown. The updated Tokyo Guidelines 2013 recommend a minimum duration of 2 weeks only when bacteremia with Gram-positive cocci is present. Since May 2013, a shorter antimicrobial treatment duration of under 2 weeks has been implemented at the authors' institution for acute cholangitis with Gram-negative bacillary bacteremia. The aim of the present study was to validate this modified practice. METHODS: A single-center retrospective cohort study was conducted. The antimicrobial treatment duration, 30-day mortality rate, and recurrence rate within 3 months were compared between patients treated before May 2013 and after May 2013. RESULTS: Ninety-one patients with cholangitis with bacteremia were analyzed. The median antimicrobial treatment duration was 14.5days in patients treated before May 2013 and 10.0days after May 2013 (p <0.001). While the 30-day mortality rate did not differ significantly, the recurrence rate was higher in those treated before May 2013 (5.7% vs. 0.0%, p=0.17 and 13.3% vs. 0.0%, p=0.03, respectively). The median treatment duration after May 2013 was 8days for grade I patients, 10days for grade II patients, and 11.5days for grade III patients. CONCLUSIONS: The results of this study suggest that acute cholangitis with Gram-negative bacillary bacteremia can be treated safely with a shorter antimicrobial treatment duration of <14 days.
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