Masuda Sakue, Imamura Yoshinori, Jinushi Ryuhei, Kubota Jun, Kimura Karen, Makazu Makomo, Sato Ryo, Kako Makoto, Kobayashi Masahiro, Uojima Haruki, Ichita Chikamasa, Koizumi Kazuya
Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital Kamakura Kanagawa Japan.
Division of Medical Oncology/Hematology, Department of Medicine Kobe University Graduate School of Medicine Kobe Hyogo Japan.
JGH Open. 2024 Mar 14;8(3):e13047. doi: 10.1002/jgh3.13047. eCollection 2024 Mar.
The appropriate duration of antimicrobial therapy for acute cholangitis (AC) arising from multiple hilar biliary obstructions as opposed to simple obstruction in the extrahepatic bile duct has not been established. This study assessed the efficacy of the duration of antimicrobial treatments in the Tokyo Guidelines 2018 for AC based on the cause and site of obstruction.
This single-center retrospective study involved patients with AC who underwent successful biliary drainage and completed a 7-day or shorter antimicrobial treatment. Patients were categorized into three groups: Group 1, bile duct stone or benign obstruction; Group 2, simple biliary obstruction due to malignancy; and Group 3, multiple hilar biliary obstruction due to malignancy. The primary outcome was clinical cure rate, and the secondary outcomes were 3-month recurrence rate and length of hospital stay.
A total of 373 patients were selected. Patients in Group 3 were younger or had Charlson Comorbidity Index ≥4, and had fewer positive blood cultures. In Group 3, the clinical cure rate (87.1%) and 3-month recurrence rate (32.3%) were less favorable than those in the other groups. In Group 1, the clinical cure rate was significantly higher (98.1%, = 0.02) with a much lower 3-month recurrence rate of only 3.4% ( < 0.001) than that in the other groups. The median hospital stay for all groups was 7 days.
This study suggests that the outcomes in Group 3 may be worse than those in Groups 1 or 2, regardless of the duration of the antibiotic treatment.
与肝外胆管单纯梗阻相比，由多处肝门部胆管梗阻引起的急性胆管炎（AC）的抗菌治疗适宜疗程尚未确定。本研究基于梗阻原因和部位，评估了《2018东京指南》中AC抗菌治疗疗程的疗效。
本单中心回顾性研究纳入了接受成功胆管引流并完成7天或更短时间抗菌治疗的AC患者。患者分为三组：第1组，胆管结石或良性梗阻；第2组，恶性肿瘤导致的单纯胆管梗阻；第3组，恶性肿瘤导致的多处肝门部胆管梗阻。主要结局为临床治愈率，次要结局为3个月复发率和住院时间。
共入选373例患者。第3组患者年龄较小或Charlson合并症指数≥4，血培养阳性率较低。在第3组中，临床治愈率（87.1%）和3个月复发率（32.3%）低于其他组。在第1组中，临床治愈率显著更高（98.1%，=0.02），3个月复发率仅为3.4%，远低于其他组（<0.001）。所有组的中位住院时间均为7天。
本研究表明，无论抗生素治疗疗程长短，第3组的结局可能比第1组或第2组更差。
