148. Retrospective Evaluation of Acute Cholangitis and Clinical Implication and Management of Secondary Bacteremia

Abstract Background Optimum duration of antimicrobial therapy for acute bacteremic cholangitis is not well established; however, 4–7 days is recommended by the 2018 Tokyo guidelines in those without Gram-positive bacteremia. Methods A retrospective study performed at Mayo Clinic - Rochester, Florida and Arizona sites was conducted, reviewing all adult patients with the first episode of acute cholangitis secondary to biliary stone obstruction, between January 1, 2012 and December 31, 2017. We reviewed the duration of prescribed antimicrobials. Results Among 331 included cases, 197(60%) were men, 66 (20%) were immuno-compromised. Presenting symptoms included fever in 202 (61.5%), abdominal pain in 289 (87%), jaundice 128(38.7%), and altered mentation in 49 (15%). Among these, 256 (77%) were classified as “definite” and 38 (11.5%) were “suspected” using the 2018 Tokyo guideline classification. Cholangitis grade was grade III in 134 (40.5%); grade II in 115 (34.7%); and grade I in 82 (24.8%). Majority of cases, 321 (97%), underwent source control—most commonly 309 (96%) achieved by endoscopic retrograde cholangiopancreatography (ERCP). Source control occurred within 24 hr of presentation in 197 (61.4%) of the cases. Bacteremia was documented in 131/277 (47%). Majority of bacteremias were due to Gram-negative organisms in 119 (91%). Mean duration of antibiotic therapy following “source control” was 9.6 days (SD 7.0). Cases with bacteremia, resulted in longer treatment duration, mean of 13 days (SD 5.6), regardless of the isolated organism. Overall 30 day mortality was 14/331 (4.2%). No mortality difference was noted in patients who underwent early (within 12 hours) vs. later source control (4.55% Vs. 4.53%), nor in those who received more or less than 6 days of antibiotic therapy after source control (4.7% Vs. 3.9%, P = 0.76). No difference in mortality was observed in those with or without bacteremia. Conclusion Our results note the use of longer courses of antimicrobials for management of bacteremic cholangitis, regardless of the organism type. This population could be a prime target for an antimicrobial stewardship intervention, to decrease the duration of prescribed antimicrobials in accordance with recent guidelines. Disclosures All authors: No reported disclosures.

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Faculty Opinions recommendation of Ertapenem administered as outpatient parenteral antibiotic therapy for urinary tract infections caused by extended-spectrum-beta-lactamase-producing Gram-negative organisms.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.3274965.2960069 ◽

2010 ◽

Author(s):

Philippe Lagacé-Wiens

Keyword(s):

Urinary Tract ◽

Antibiotic Therapy ◽

Urinary Tract Infections ◽

Beta Lactamase ◽

Parenteral Antibiotic ◽

Gram Negative ◽

Extended Spectrum Beta Lactamase ◽

Extended Spectrum ◽

Gram Negative Organisms ◽

Tract Infections

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The impact of infectious diseases consultation on the management and outcomes of Pseudomonas aeruginosa bacteraemia in adults: a retrospective cohort study

BMC Infectious Diseases ◽

10.1186/s12879-021-06372-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fabian Chiong ◽

Mohammed S. Wasef ◽

Kwee Chin Liew ◽

Raquel Cowan ◽

Danny Tsai ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Infectious Diseases ◽

Retrospective Cohort ◽

Source Control ◽

First Episode ◽

Oral Antibiotic ◽

Genotypic Analysis ◽

Infectious Diseases Consultation ◽

Staphylococcal Aureus ◽

The Impact

Abstract Background Pseudomonas aeruginosa bacteraemia (PAB) is associated with high mortality. The benefits of infectious diseases consultation (IDC) has been demonstrated in Staphylococcal aureus bacteraemia and other complex infections. Impact of IDC in PAB is unclear. This study aimed to evaluate the impact of IDC on the management and outcomes in patients with PAB. Methods This is a retrospective cohort single-centre study from 1 November 2006 to 29 May 2019, in all adult patients admitted with first episode of PAB. Data collected included demographics, clinical management and outcomes for PAB and whether IDC occurred. In addition, 29 Pseudomonas aeruginosa (PA) stored isolates were available for Illumina whole genome sequencing to investigate if pathogen factors contributed to the mortality. Results A total of 128 cases of PAB were identified, 71% received IDC. Patients who received IDC were less likely to receive inappropriate duration of antibiotic therapy (4.4%; vs 67.6%; p < 0.01), more likely to be de-escalated to oral antibiotic in a timely manner (87.9% vs 40.5%; p < 0.01), undergo removal of infected catheter (27.5% vs 13.5%; p = 0.049) and undergo surgical intervention (20.9% vs 5.4%, p = 0.023) for source control. The overall 30-day all-cause mortality rate was 24.2% and was significantly higher in the no IDC group in both unadjusted (56.8% vs 11.0%, odds ratio [OR] = 10.63, p < 0.001) and adjusted analysis (adjusted OR = 7.84; 95% confidence interval, 2.95–20.86). The genotypic analysis did not reveal any PA genetic features associated with increased mortality between IDC versus no IDC groups. Conclusion Patients who received IDC for PAB had lower 30-day mortality, better source control and management was more compliant with guidelines. Further prospective studies are necessary to determine if these results can be validated in other settings.

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Validation of Tokyo Guidelines 2007 and Tokyo Guidelines 2013/2018 Criteria for Acute Cholangitis and Predictors of In-Hospital Mortality

Visceral Medicine ◽

10.1159/000516424 ◽

2021 ◽

pp. 1-9

Author(s):

Ramkumar Mohan ◽

Stefanie Wei Lynn Goh ◽

Guan Wei Tan ◽

Yen Pin Tan ◽

Sameer P. Junnarkar ◽

...

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Hospital Mortality ◽

Diagnostic Criteria ◽

Glasgow Coma Score ◽

Acute Cholangitis ◽

Tokyo Guidelines

Background: Acute cholangitis (AC) is a common emergency with a significant mortality risk. The Tokyo Guidelines (TG) provide recommendations for diagnosis, severity stratification, and management of AC. However, validation of the TG remains poor. This study aims to validate TG07, TG13, and TG18 criteria and identify predictors of in-hospital mortality in patients with AC. Methods: This is a retrospective audit of patients with a discharge diagnosis of AC in the year 2016. Demographic, clinical, investigation, management and mortality data were documented. We performed a multinomial logistic regression analysis with stepwise variable selection to identify severity predictors for in-hospital mortality. Results: Two hundred sixty-two patients with a median age of 75.9 years (IQR 64.8–82.8) years were included for analysis. TG13/TG18 diagnostic criteria were more sensitive than TG07 diagnostic criteria (85.1 vs. 75.2%; p < 0.006). The majority of the patients (n = 178; 67.9%) presented with abdominal pain, pyrexia (n = 156; 59.5%), and vomiting (n = 123; 46.9%). Blood cultures were positive in 95 (36.3%) patients, and 79 (83.2%) patients had monomicrobial growth. The 30-day, 90-day, and in-hospital mortality numbers were 3 (1.1%), 11 (4.2%), and 15 (5.7%), respectively. In multivariate analysis, type 2 diabetes mellitus (OR = 12.531; 95% CI 0.354–116.015; p = 0.026), systolic blood pressure <100 mm Hg (OR = 10.108; 95% CI 1.094–93.395; p = 0.041), Glasgow coma score <15 (OR = 38.16; 95% CI 1.804–807.191; p = 0.019), and malignancy (OR = 14.135; 95% CI 1.017–196.394; p = 0.049) predicted in-hospital mortality. Conclusion: TG13/18 diagnostic criteria are more sensitive than TG07 diagnostic criteria. Type 2 diabetes mellitus, systolic blood pressure <100 mm Hg, Glasgow coma score <15, and malignant etiology predict in-hospital mortality in patients with AC. These predictors could be considered in acute stratification and treatment of patients with AC.

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The presence of acute cholangitis defined by 2013 Tokyo Guidelines (TG13) in acute necrotising pancreatitis is associated with poor outcomes

HPB ◽

10.1016/j.hpb.2019.10.798 ◽

2019 ◽

Vol 21 ◽

pp. S815

Author(s):

E. Pando Rau ◽

P. Alberti Delgado ◽

L. Blanco Cuso ◽

M. Caralt Barba ◽

C. Dopazo Taboada ◽

...

Keyword(s):

Acute Cholangitis ◽

Tokyo Guidelines ◽

Necrotising Pancreatitis ◽

Acute Necrotising Pancreatitis ◽

Poor Outcomes ◽

Acute Necrotising

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4683 Acute cholangitis: pathogens and antibiotic therapy.

Gastrointestinal Endoscopy ◽

10.1016/s0016-5107(00)14530-4 ◽

2000 ◽

Vol 51 (4) ◽

pp. AB202

Author(s):

Colin Rodgers ◽

Anne C. Loughrey ◽

Tony Ck Tham

Keyword(s):

Antibiotic Therapy ◽

Acute Cholangitis

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Comparison of two editions of Tokyo guidelines for the management of acute cholangitis

Journal of Hepato-Biliary-Pancreatic Sciences ◽

10.1002/jhbp.9 ◽

2013 ◽

Vol 21 (2) ◽

pp. 113-119 ◽

Cited By ~ 9

Author(s):

Gang Sun ◽

Lu Han ◽

Yunsheng Yang ◽

Enqiang Linghu ◽

Wen Li ◽

...

Keyword(s):

Acute Cholangitis ◽

Tokyo Guidelines

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Progression of Tokyo Guidelines and Japanese Guidelines for Management of Acute Cholangitis and Cholecystitis

Journal of UOEH ◽

10.7888/juoeh.35.249 ◽

2013 ◽

Vol 35 (4) ◽

pp. 249-257 ◽

Cited By ~ 13

Author(s):

Toshihiko MAYUMI ◽

Kazuki SOMEYA ◽

Hiroki OOTUBO ◽

Tatsuo TAKAMA ◽

Takashi KIDO ◽

...

Keyword(s):

Acute Cholangitis ◽

Tokyo Guidelines ◽

Japanese Guidelines

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Su1651 Clinical Evaluation of Tokyo Guidelines 2013 for Severity Assessment of Acute Cholangitis

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2015.03.1499 ◽

2015 ◽

Vol 81 (5) ◽

pp. AB365

Author(s):

Takayoshi Nishino ◽

Tetsuya Hamano ◽

Izumi Shirato ◽

Yutaka Mitsunaga ◽

Miho Shirato ◽

...

Keyword(s):

Clinical Evaluation ◽

Acute Cholangitis ◽

Severity Assessment ◽

Tokyo Guidelines

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Tonsillectomy in IgA Nephropathy - Clinical Case

Acta Medica Transilvanica ◽

10.2478/amtsb-2021-0053 ◽

2021 ◽

Vol 26 (3) ◽

pp. 59-61

Author(s):

Livia Mirela Popa ◽

Livia Popa ◽

Cătălin-Bogdan Osalciuc

Keyword(s):

Antibiotic Therapy ◽

Iga Nephropathy ◽

Clinical Case ◽

Acute Infection ◽

Acute Onset ◽

First Episode ◽

Urinary Volume ◽

Upper Airways ◽

Macroscopic Hematuria ◽

Nephritic Syndrome

Abstract This article presents the clinical case of IgA nephropathy of a patient hospitalized in order to investigate a nephritic syndrome, apparently with acute onset, discovered in the following circumstances: recurrent macroscopic hematuria, decreased urinary volume, the first episode occurring about a month ago in the context of an acute infection of upper airways, remitted under antibiotic therapy, with reappearance every 2 weeks, also accompanied by odynophagia and decreased urinary volume.

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