Department of Pharmacy, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan; Infection Control Team, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan.
Infection Control Team, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan; Department of Infectious Diseases, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
J Infect Chemother. 2024 May;30(5):423-428. doi: 10.1016/j.jiac.2023.11.015. Epub 2023 Nov 18.
Cefmetazole (CMZ), an antibiotic with limited international distribution, is recommended by the Tokyo Guidelines 2018 (TG18) for non-severe cases of acute cholangitis (AC). However, the risk factors for CMZ-non-susceptible (CMZ-NS) bacteremia in AC remain unclear. Here, we aimed to investigate the risk factors for CMZ-NS bacteremia and evaluate mortality in patients with AC.
This single-center, retrospective, observational study included all patients diagnosed with definite bacteremic AC, based on TG18, from April 2019 to March 2023. Risk factors for CMZ-NS bacteremia were analyzed by univariate, and age- and sex-adjusted, logistic regression analyses. Mortality was compared by cause of obstruction, CMZ-susceptible/CMZ-NS bacteremia, and initial treatment.
In total, 165 patients were enrolled. CMZ-NS bacteremia was diagnosed in 46 (27.9 %) patients. Histories of diabetes mellitus, hepato-biliary-pancreatic cancer, malignant biliary obstruction, and endoscopic sphincterotomy were identified as significant factors associated with the risk of CMZ-NS bacteremia. Thirteen patients died within 30 days of hospital admission. The mortality of patients with AC and malignant biliary obstruction was statistically higher than that of patients with bile duct stones. No patients with AC and bile duct stones died in the group with CMZ-NS bacteremia and inappropriate initial antibiotics.
In AC, a history of diabetes mellitus, hepato-biliary-pancreatic cancer, malignant biliary obstruction, and endoscopic sphincterotomy are associated with an increased risk of CMZ-NS bacteremia. Therefore, the choice of empiric therapy for AC should be based on the etiology and patient background, rather than on the severity.
头孢美唑（CMZ）是一种国际供应有限的抗生素，2018 年东京指南（TG18）推荐用于非重症急性胆囊炎（AC）。然而，AC 中 CMZ 不敏感（CMZ-NS）菌血症的危险因素仍不清楚。在此，我们旨在研究 AC 中 CMZ-NS 菌血症的危险因素，并评估 AC 患者的死亡率。
这是一项单中心、回顾性、观察性研究，纳入了 2019 年 4 月至 2023 年 3 月期间根据 TG18 诊断为明确菌血症性 AC 的所有患者。采用单因素和年龄、性别校正的逻辑回归分析方法分析 CMZ-NS 菌血症的危险因素。通过梗阻原因、CMZ 敏感/CMZ-NS 菌血症和初始治疗来比较死亡率。
共纳入 165 例患者。46 例（27.9%）患者诊断为 CMZ-NS 菌血症。糖尿病、肝胆胰恶性肿瘤、恶性胆道梗阻和内镜下括约肌切开术的病史被确定为与 CMZ-NS 菌血症风险相关的显著因素。13 例患者在入院后 30 天内死亡。AC 合并恶性胆道梗阻患者的死亡率明显高于胆管结石患者。在 CMZ-NS 菌血症和初始抗生素不恰当的患者中，无胆管结石 AC 患者死亡。
在 AC 中，糖尿病、肝胆胰恶性肿瘤、恶性胆道梗阻和内镜下括约肌切开术的病史与 CMZ-NS 菌血症风险增加相关。因此，AC 的经验性治疗选择应基于病因和患者背景，而不是严重程度。
