Gut Liver.  2020 Nov;14(6):842-849. 10.5009/gnl19248.

Impact of the Sensitivity to Empiric Antibiotics on Clinical Outcomes after Biliary Drainage for Acute Cholangitis

• Kawamura S
• Karasawa Y
• Toda N
• Nakai Y
• Shibata C
• Kurokawa K
• Arai J
• Funato K
• Kurosaki S
• Maeshima S
• Kondo M
• Kojima K
• Ohki T
• Seki M
• Koike K
• Tagawa K

• KMID: 2508703
• DOI: http://doi.org/10.5009/gnl19248

Abstract

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.

Keyword

Endoscopic retrograde cholangiopancreatography; Cholangitis; Antimicrobial agents