Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan; Department of Infection Control Science, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan.
Clin Microbiol Infect. 2017 Oct;23(10):740-747. doi: 10.1016/j.cmi.2017.02.027. Epub 2017 Feb 28.
Acute cholangitis is a common cause of bacteraemia resulting in severe sepsis or septic shock. The impact of the appropriate initial antimicrobial therapy on short-term mortality in bacteraemic cholangitis has not been well investigated.
We conducted a retrospective cohort study of patients with bacteraemic cholangitis at two large tertiary care centres in Tokyo, Japan between 2009 and 2015. We determined the factors associated with 30-day all-cause mortality from the date of drawing the first positive blood culture, using a multivariate logistic regression analysis.
We identified 573 patients with bacteraemic cholangitis (median age, 77 years; male, 58.3%). The 30-day all-cause mortality rate was 6.6% (38/573). Inadequate initial antimicrobial therapy occurred in 133 (23.2%) patients. Factors associated with 30-day all-cause mortality included the Charlson co-morbidity index score >3 (adjusted odds ratio (aOR) 4.12; 95% CI 1.18-14.38), jaundice (total bilirubin >2.5 mg/dL) (aOR 3.39; 95% CI 1.46-7.89), septic shock within 48 h of the first positive blood culture (aOR 3.34; 95% CI 1.42-7.89), biliary obstruction due to hepatobiliary malignancy (aOR 8.00; 95% CI 2.92-21.97), and inadequate initial antimicrobial therapy (aOR 2.78; 95% CI 1.27-6.11).
Inadequate initial antimicrobial therapy was an important, modifiable determinant of survival.
急性胆管炎是导致严重脓毒症或感染性休克的常见菌血症病因。适当的初始抗菌治疗对菌血症性胆管炎患者短期死亡率的影响尚未得到充分研究。
我们对 2009 年至 2015 年期间在日本东京的两家大型三级保健中心发生菌血症性胆管炎的患者进行了回顾性队列研究。我们使用多变量逻辑回归分析确定了从首次阳性血培养之日起 30 天内全因死亡率的相关因素。
我们确定了 573 例菌血症性胆管炎患者（中位年龄为 77 岁；男性占 58.3%）。30 天全因死亡率为 6.6%（38/573）。初始抗菌治疗不充分的患者有 133 例（23.2%）。与 30 天全因死亡率相关的因素包括 Charlson 合并症指数评分>3（调整后的优势比[aOR]4.12；95%CI1.18-14.38）、黄疸（总胆红素>2.5mg/dL）（aOR3.39；95%CI1.46-7.89）、首次阳性血培养后 48 小时内发生感染性休克（aOR3.34；95%CI1.42-7.89）、肝胆恶性肿瘤引起的胆道梗阻（aOR8.00；95%CI2.92-21.97）和初始抗菌治疗不充分（aOR2.78；95%CI1.27-6.11）。
初始抗菌治疗不充分是生存的一个重要的、可改变的决定因素。
