Impact of the Sensitivity to Empiric Antibiotics on Clinical Outcomes after Biliary Drainage for Acute Cholangitis.
Antimicrobial agents
Cholangitis
Endoscopic retrograde cholangiopancreatography
Journal
Gut and liver
ISSN: 2005-1212
Titre abrégé: Gut Liver
Pays: Korea (South)
ID NLM: 101316452
Informations de publication
Date de publication:
15 11 2020
15 11 2020
Historique:
received:
18
05
2019
revised:
20
10
2019
accepted:
03
11
2019
pubmed:
14
2
2020
medline:
26
8
2021
entrez:
14
2
2020
Statut:
ppublish
Résumé
Empiric antibiotics are given in combination with biliary drainage for acute cholangitis but sometimes turn out to be insensitive to microorganisms in blood and bile. Clinical outcomes were compared according to sensitivity to microorganisms detected in blood and bile culture to evaluate the impact of sensitivity to empiric antibiotics in cholangitis. Consecutive patients who underwent biliary drainage for acute cholangitis were retrospectively studied. Clinical outcomes such as 30-day mortality, length of hospital stay and high care unit stay, organ dysfunction and duration of fever were compared in three groups: group A (sensitive to both blood and bile culture), group B (sensitive to blood culture alone) and group C (insensitive to both blood and bile culture). Eighty episodes of cholangitis were classified according to sensitivity results: 42, 32 and six in groups A, B and C. Escherichia coli and Klebsiella were two major pathogens. There were no significant differences in 30-day mortality rate (7%, 0%, and 0%, p=0.244), length of hospital stay (28.5, 21.0, and 20.5 days, p=0.369), organ dysfunction rate (14%, 25%, and 17%, p=0.500), duration of fever (4.3, 3.2, and 3.5 days, p=0.921) and length of high care unit stay (1.4, 1.2, and 1.7 days, p=0.070) in groups A, B and C. Empiric antibiotics were changed in 11 episodes but clinical outcomes appeared to be non-inferior even in 31 episodes of cholangitis who were on inadequate antibiotics throughout the course. Sensitivity of empiric antibiotics was not associated with clinical outcomes in acute cholangitis.
Sections du résumé
Background/Aims
Empiric antibiotics are given in combination with biliary drainage for acute cholangitis but sometimes turn out to be insensitive to microorganisms in blood and bile. Clinical outcomes were compared according to sensitivity to microorganisms detected in blood and bile culture to evaluate the impact of sensitivity to empiric antibiotics in cholangitis.
Methods
Consecutive patients who underwent biliary drainage for acute cholangitis were retrospectively studied. Clinical outcomes such as 30-day mortality, length of hospital stay and high care unit stay, organ dysfunction and duration of fever were compared in three groups: group A (sensitive to both blood and bile culture), group B (sensitive to blood culture alone) and group C (insensitive to both blood and bile culture).
Results
Eighty episodes of cholangitis were classified according to sensitivity results: 42, 32 and six in groups A, B and C. Escherichia coli and Klebsiella were two major pathogens. There were no significant differences in 30-day mortality rate (7%, 0%, and 0%, p=0.244), length of hospital stay (28.5, 21.0, and 20.5 days, p=0.369), organ dysfunction rate (14%, 25%, and 17%, p=0.500), duration of fever (4.3, 3.2, and 3.5 days, p=0.921) and length of high care unit stay (1.4, 1.2, and 1.7 days, p=0.070) in groups A, B and C. Empiric antibiotics were changed in 11 episodes but clinical outcomes appeared to be non-inferior even in 31 episodes of cholangitis who were on inadequate antibiotics throughout the course.
Conclusions
Sensitivity of empiric antibiotics was not associated with clinical outcomes in acute cholangitis.
Identifiants
pubmed: 32050314
pii: gnl19248
doi: 10.5009/gnl19248
pmc: PMC7667925
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
842-849Références
Gastrointest Endosc. 2010 Aug;72(2):284-91
pubmed: 20541201
Lancet. 1989 Jun 10;1(8650):1307-9
pubmed: 2566834
J Antimicrob Chemother. 2010 Dec;65(12):2658-65
pubmed: 20947620
Clin Microbiol Infect. 2017 Oct;23(10):740-747
pubmed: 28254686
Medicine (Baltimore). 2016 Mar;95(10):e2390
pubmed: 26962768
Clin Microbiol Infect. 2011 Jul;17(7):1078-83
pubmed: 20946408
J Hepatobiliary Pancreat Sci. 2013 Jan;20(1):60-70
pubmed: 23340954
N Engl J Med. 1992 Jun 11;326(24):1582-6
pubmed: 1584258
Dig Endosc. 2017 Apr;29 Suppl 2:70-77
pubmed: 28425650
Antimicrob Agents Chemother. 2005 Feb;49(2):760-6
pubmed: 15673761
J Gastroenterol. 2011 Dec;46(12):1411-7
pubmed: 21842232
Scand J Infect Dis. 2013 Mar;45(3):227-34
pubmed: 23113605
Chest. 2000 Jul;118(1):146-55
pubmed: 10893372
Infection. 2011 Aug;39(4):309-18
pubmed: 21594653
Gut. 1984 Sep;25(9):988-98
pubmed: 6381248
Am J Gastroenterol. 2012 Mar;107(3):473-83
pubmed: 22334249
J Hepatobiliary Pancreat Sci. 2013 Jan;20(1):24-34
pubmed: 23307001
J Infect. 2010 Oct;61(4):299-306
pubmed: 20670652
Am J Med. 2003 Nov;115(7):529-35
pubmed: 14599631
J Gastroenterol. 2017 Jun;52(6):734-745
pubmed: 27783206
J Infect. 2017 Feb;74(2):172-178
pubmed: 27826062
Am J Gastroenterol. 2007 Mar;102(3):563-9
pubmed: 17335448