Y Tagashira1, N Sakamoto2, T Isogai3, M Hikone2, A Kosaka2, R Chino4, M Higuchi4, Y Uehara5, H Honda6. 1. Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan; Department of Infection Control Science, Juntendo University Graduate School of Medicine, Tokyo, Japan. 2. Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan. 3. Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan. 4. Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan. 5. Department of Infection Control Science, Juntendo University Graduate School of Medicine, Tokyo, Japan. 6. Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan. Electronic address: hondah@hotmail.com.
Abstract
OBJECTIVES: Acute cholangitis is a common cause of bacteraemia resulting in severe sepsis or septic shock. The impact of the appropriate initial antimicrobial therapy on short-term mortality in bacteraemic cholangitis has not been well investigated. METHODS: We conducted a retrospective cohort study of patients with bacteraemic cholangitis at two large tertiary care centres in Tokyo, Japan between 2009 and 2015. We determined the factors associated with 30-day all-cause mortality from the date of drawing the first positive blood culture, using a multivariate logistic regression analysis. RESULTS: We identified 573 patients with bacteraemic cholangitis (median age, 77 years; male, 58.3%). The 30-day all-cause mortality rate was 6.6% (38/573). Inadequate initial antimicrobial therapy occurred in 133 (23.2%) patients. Factors associated with 30-day all-cause mortality included the Charlson co-morbidity index score >3 (adjusted odds ratio (aOR) 4.12; 95% CI 1.18-14.38), jaundice (total bilirubin >2.5 mg/dL) (aOR 3.39; 95% CI 1.46-7.89), septic shock within 48 h of the first positive blood culture (aOR 3.34; 95% CI 1.42-7.89), biliary obstruction due to hepatobiliary malignancy (aOR 8.00; 95% CI 2.92-21.97), and inadequate initial antimicrobial therapy (aOR 2.78; 95% CI 1.27-6.11). CONCLUSIONS: Inadequate initial antimicrobial therapy was an important, modifiable determinant of survival.
OBJECTIVES: Acute cholangitis is a common cause of bacteraemia resulting in severe sepsis or septic shock. The impact of the appropriate initial antimicrobial therapy on short-term mortality in bacteraemic cholangitis has not been well investigated. METHODS: We conducted a retrospective cohort study of patients with bacteraemic cholangitis at two large tertiary care centres in Tokyo, Japan between 2009 and 2015. We determined the factors associated with 30-day all-cause mortality from the date of drawing the first positive blood culture, using a multivariate logistic regression analysis. RESULTS: We identified 573 patients with bacteraemic cholangitis (median age, 77 years; male, 58.3%). The 30-day all-cause mortality rate was 6.6% (38/573). Inadequate initial antimicrobial therapy occurred in 133 (23.2%) patients. Factors associated with 30-day all-cause mortality included the Charlson co-morbidity index score >3 (adjusted odds ratio (aOR) 4.12; 95% CI 1.18-14.38), jaundice (total bilirubin >2.5 mg/dL) (aOR 3.39; 95% CI 1.46-7.89), septic shock within 48 h of the first positive blood culture (aOR 3.34; 95% CI 1.42-7.89), biliary obstruction due to hepatobiliary malignancy (aOR 8.00; 95% CI 2.92-21.97), and inadequate initial antimicrobial therapy (aOR 2.78; 95% CI 1.27-6.11). CONCLUSIONS: Inadequate initial antimicrobial therapy was an important, modifiable determinant of survival.
Authors: Marco Mussa; Pedro María Martínez Pérez-Crespo; Luis Eduardo Lopez-Cortes; Pilar Retamar-Gentil; Adrián Sousa-Dominguez; Ane Josune Goikoetxea-Aguirre; José María Reguera-Iglesias; Eva León Jiménez; Isabel Fernández-Natal; Carlos Armiñanzas-Castillo; Lucía Boix-Palop; Jordi Cuquet-Pedragosa; Miguel Ángel Morán Rodríguez; Jonathan Fernandez-Suarez; Alfonso Del Arco-Jiménez; Alfredo Jóver-Saenz; Alberto Bahamonde-Carrasco; Fátima Galan-Sanchez; Juan Manuel Sánchez-Calvo; Alejandro Smithson-Amat; David Vinuesa-García; Antonio Sánchez-Porto; Inmaculada López-Hernández; Jesús Rodríguez-Baño Journal: Microbiol Spectr Date: 2022-06-30