1212. Effectiveness of Short-Course Antimicrobial Therapy compared with Long-Course Therapy for Acute Cholangitis
Session: Poster Abstract Session: Clinical Infectious Diseases: Enteric Infections
Friday, October 28, 2016
Room: Poster Hall
Posters
  • 1212.jpg (92.6 kB)
  • Background: Antimicrobial therapy with biliary drainage is required for the management of acute cholangitis. Duration of antimicrobial therapy, however, remains unclear.
    Methods: We conducted historical cohort study enrolling 152 patients with culture confirmed acute cholangitis diagnosed from 2012 to 2014 at Kobe City Medical Center General Hospital in Kobe, Japan. We defined Short-Course antimicrobial therapy (SCT) as total duration of antimicrobials for 7 days or less, and compared with Long-Course treatment, where the patients were provided antimicrobials for 8 days or more (LCT). Primary outcome was 30-day mortality. We used logistic regression models to estimate odds ratio (OR) of SCT compared to LCT adjusting for qSOFA score. As a sensitivity analysis, we also developed propensity score of SCT and augmented inverse probability weighting methods was used.
    Results: Mean age of the study patients was 77 year old (range 52-102). Fifty patients received SCT and 102 patients were on LCT. Median duration of antimicrobial therapy on SCT and LCT were 6 (range 2-7) and 12 days (range 8-44) respectively. Most accompanied bacteremia (96.7%). Median qSOFA on SCT and LCT were 1(range 0-2) and 1(range 0-3) respectively (p=0.01). We were able to determine the primary outcome in 150 patients (98.8%). The mortality on SCT and LCT were 4.1% and 8.9% respectively (p=0.51). There was no significant difference in relapse (2.6% vs 6.1%, p=0.66), recrudescence 2.6% vs 4.9%, p=1.00), abscess formation (0% vs 1.4%, p=1.00), or other complications (16.2% vs 9.5%, p=0.35). Logistic regression model revealed that OR of SCT in 30-day mortality was 0.64 (95% CI 0.13-3.25, p=0.59). The result of a augmented inverse probability weighting was similar.
    Conclusion: Short-Course antimicrobial therapy with median duration of 6 days did not show apparent beneficial or harmful effects on 30-day mortality of the patients with acute cholangitis. This finding should be scrutinized with large randomized trials.
    Kentaro Iwata, MD, PhD, FACP, FIDSA, Division of Infectious Diseases Therapeutics, Department of Microbiology and Infectious Diseases, Kobe University Graduate School of Medicine, Kobe, Japan, Asako Doi, MD, Dept. of Infectious Diseases, Kobe City Medical Center General Hospital, Kobe, Japan and Takeshi Morimoto, MD, PhD, MPH, FACP, Kobe City Medical Center General Hospital, Kobe, Japan

    Disclosures:

    K. Iwata, None

    A. Doi, None

    T. Morimoto, None

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