Department of Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518, Japan.
Department of Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518, Japan.
J Infect Chemother. 2022 Feb;28(2):181-186. doi: 10.1016/j.jiac.2021.10.004. Epub 2021 Oct 9.
Despite the high frequency of bacteremia in acute cholangitis, the indications for blood cultures and the relationship between the incidence of bacteremia and severity of acute cholangitis have not been well established. This study examined the association between the 2018 Tokyo Guidelines (TG18) severity grading for acute cholangitis and incidence of bacteremia to identify the need for blood cultures among patients with acute cholangitis in each severity grade.
Patients with acute cholangitis who visited our emergency department between 2019 and 2020 were retrospectively investigated. Patients administered antibiotics within 48 h of hospital arrival, whose prothrombin time-international normalized ratios were not measured, or who were suspected of false bacteremia were excluded.
Out of the included 358 patients with acute cholangitis, blood cultures were collected from 310 (87%) patients, of which 148 (48%) were complicated with bacteremia. As the TG18 severity grading increased, the frequency of bacteremia increased (Grade I, 35% [59/171]; Grade II, 59% [48/82]; Grade III, 74% [42/57]; P <0.001). Agreement with the TG18 diagnostic criteria (unfulfilled, suspected, or definite) was not different between patients with and without bacteremia; however, 36% (14/39) of the patients with "unfulfilled" criteria were complicated with bacteremia.
As the severity of acute cholangitis increased, the frequency of bacteremia increased; however, the incidence of bacteremia was high even in mild cases and cases that did not meet the TG18 diagnostic criteria. Blood cultures should be collected regardless of the severity of acute cholangitis for patients who visit the emergency department.
尽管急性胆管炎患者中菌血症的发生率很高，但菌血症的指征以及菌血症的发生与急性胆管炎严重程度之间的关系尚未得到很好的确定。本研究检查了 2018 年东京指南（TG18）对急性胆管炎严重程度分级与菌血症发生率之间的关系，以确定在每个严重程度级别中，急性胆管炎患者是否需要进行血培养。
回顾性调查了 2019 年至 2020 年期间我院急诊科就诊的急性胆管炎患者。排除了在入院 48 小时内使用抗生素、未测量国际标准化比值（prothrombin time-international normalized ratios）或疑似假菌血症的患者。
在纳入的 358 例急性胆管炎患者中，有 310 例（87%）采集了血培养，其中 148 例（48%）合并菌血症。随着 TG18 严重程度分级的增加，菌血症的发生率也随之增加（Ⅰ级，35%[59/171]；Ⅱ级，59%[48/82]；Ⅲ级，74%[42/57]；P<0.001）。合并菌血症与未合并菌血症患者的 TG18 诊断标准符合率（未满足、疑似或明确）无差异；然而，“未满足”标准的患者中有 36%（14/39）合并菌血症。
随着急性胆管炎严重程度的增加，菌血症的发生率也随之增加；然而，即使在轻度病例和不符合 TG18 诊断标准的病例中，菌血症的发生率也很高。对于就诊于急诊科的患者，无论急性胆管炎的严重程度如何，均应采集血培养。
