Shorter Duration of Antibiotic Treatment for Acute Bacteraemic Cholangitis with Successful Biliary Drainage:A Retrospective Cohort Study.
Clin Microbiol Infect. 2018 Feb 02;:
Authors: Doi A, Morimoto T, Iwata K
OBJECTIVES: To assess the effectiveness of short duration antimicrobial therapy for acute cholangitis with bacteraemia.
METHODS: We conducted a retrospective cohort study of patients with acute bacteraemic cholangitis with successful biliary duct drainage at a single centre in Japan. We compared short-course antimicrobial therapy (SCT, ≤7 days) and long-course therapy (LCT, ≥8 days), with a primary outcome of 30-day mortality. We constructed logistic regression models for mortality and a composite outcome, including mortality, recurrence, recrudescence, new bacteraemia, liver abscess or other complications related to cholangitis. We also developed a propensity score for SCT with inverse probability weighting (IPW) for both the primary outcome and the composite outcome.
RESULTS: We identified 263 patients in our cohort. Eighty-six (32.7%) patients received SCT and the remaining 177 (67.3%) received LCT. The median duration of SCT and LCT was 6 (range, 2-7) and 12 days (range, 8-46 days), respectively. The 30-day mortality of SCT and LCT were 4.7% (4/85) and 5.7% (10/176), respectively (P=1.00). Logistic regression analysis showed that the odds ratio of SCT for 30-day mortality and the composite outcome were 1.07 (95% CI 0.25-4.52, P=0.93), and 1.08 (95% CI 0.48-2.45, P=0.85) respectively. Propensity score analyses for both 30-day mortality and the composite outcome did not demonstrate a difference between SCT and LCT (P=0.65 and 0.95 respectively).
CONCLUSIONS: SCT with a median duration of 6 days did not have worse outcomes than LCT with a median duration of 12 days. Shortening the duration of antimicrobial therapy may be a reasonable option when treating acute bacteraemic cholangitis following successful biliary drainage.
PMID: 29408612 [PubMed - as supplied by publisher]