Short-course antimicrobial treatment for acute cholangitis with Gram-negative bacillary bacteremia

Shunsuke Uno, Ryota Hase, Masayoshi Kobayashi, Toshiyasu Shiratori, So Nakaji, Nobuto Hirata, Naoto Hosokawa

Research output: Contribution to journalArticle

10 Citations (Scopus)

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 14.5 days in patients treated before May 2013 and 10.0 days 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 8 days for grade I patients, 10 days for grade II patients, and 11.5 days 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.

Original languageEnglish
Pages (from-to)81-85
Number of pages5
JournalInternational Journal of Infectious Diseases
Volume55
DOIs
Publication statusPublished - 2017 Feb 1

Keywords

  • Acute cholangitis
  • Antimicrobial stewardship
  • Bacteremia
  • Drainage

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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