Session: Poster Abstract Session: Clinical Infectious Diseases: Enteric Infections
Friday, October 28, 2016
Room: Poster Hall
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.
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.
Disclosures:
K. Iwata,
None
T. Morimoto, None