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

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.

Keywords

• Antimicrobial stewardship
• Acute cholangitis
• Bacteremia
• Drainage