1.Impact of the Sensitivity to Empiric Antibiotics on Clinical Outcomes after Biliary Drainage for Acute Cholangitis
Satoshi KAWAMURA ; Yuki KARASAWA ; Nobuo TODA ; Yousuke NAKAI ; Chikako SHIBATA ; Ken KUROKAWA ; Junya ARAI ; Kazuyoshi FUNATO ; Shigeyuki KUROSAKI ; Shuya MAESHIMA ; Mayuko KONDO ; Kentaro KOJIMA ; Takamasa OHKI ; Michiharu SEKI ; Kazuhiko KOIKE ; Kazumi TAGAWA
Gut and Liver 2020;14(6):842-849
Background/Aims:
Empiric antibiotics are given in combina-tion 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 sensitiv-ity 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 31episodes of cholangitis who were on inadequate antibiotics throughout the course.
Conclusions
Sensitivity of empiric antibiotics was not associated with clinical outcomes in acute cholangitis.
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