内镜逆行胰胆管造影术后革兰氏阳性球菌菌血症所致急性胆管炎的短疗程与长疗程抗菌治疗比较
Comparison between short-course and long-course antimicrobial treatments for acute cholangitis with gram-positive coccus bacteremia after endoscopic retrograde cholangiopancreatography.
作者信息
Kim Yuntae, Ishikawa Kazuhiro, Nakamura Kenji, Ikusaka Hikaru, Yokosuka Ryohsuke, Yamazaki Tomohiro, Suzuki Yuichiro, Okuyama Shuhei, Takagi Koichi, Fukuda Katsuyuki
机构信息
Department of Gastroenterology, St. Luke's International Hospital, Tokyo 104-8560, Japan.
Department of Infectious Diseases, St. Luke's International Hospital, Tokyo 104-8560, Japan.
出版信息
World J Hepatol. 2025 Jun 27;17(6):108100. doi: 10.4254/wjh.v17.i6.108100.
BACKGROUND
The optimal duration of antimicrobial treatment for acute cholangitis complicated by gram-positive coccus (GPC) bacteremia remains unclear. The Tokyo Guidelines 2018 recommended 14 days of antimicrobial treatment following adequate source control measures; however, evidence supporting this recommendation is limited, and deviations from real-world practice are often observed.
AIM
To evaluate the efficacy and safety of shorter antimicrobial treatments for acute cholangitis complicated by GPC bacteremia.
METHODS
Adult patients with acute cholangitis complicated by GPC bacteremia who underwent endoscopic retrograde cholangiopancreatography between July 2003 and December 2023 were included. Patients were categorized into two groups based on the duration of effective antimicrobial treatment: (1) Short-course treatment (SCT) (< 14 days); and (2) Long-course treatment (LCT) (≥ 14 days). The outcomes assessed included mortality, recurrence, reinfection with the same organism related to the cholangitis, and length of hospital stay.
RESULTS
A total of 44 patients were included in the study: (1) 19 patients in the SCT group; and (2) 25 patients in the LCT group. The median duration of antimicrobial treatment was 9 days [interquartile range (IQR): 2.5-11.0 days] and 16 days (IQR: 15.0-19.0 days) in the SCT and LCT groups, respectively, with a statistically significant difference ( < 0.05). No significant differences were observed in 30-day mortality, cholangitis recurrence, or reinfection with the same organisms within 3 months. However, the length of hospital stay was shorter in the SCT group (median: 12.0 days 14.0 days, = 0.092).
CONCLUSION
For acute cholangitis complicated by GPC bacteremia, shorter antimicrobial treatment may be a viable option following appropriate biliary drainage. Further studies with larger sample sizes are warranted.
背景
急性胆管炎合并革兰氏阳性球菌（GPC）菌血症的抗菌治疗最佳疗程仍不明确。《2018年东京指南》建议在采取充分的源头控制措施后进行14天的抗菌治疗；然而，支持该建议的证据有限，且在实际临床实践中常出现与该建议不符的情况。
目的
评估针对急性胆管炎合并GPC菌血症采用较短疗程抗菌治疗的疗效和安全性。
方法
纳入2003年7月至2023年12月期间接受内镜逆行胰胆管造影术的急性胆管炎合并GPC菌血症的成年患者。根据有效抗菌治疗的疗程将患者分为两组：（1）短疗程治疗（SCT）（<14天）；（2）长疗程治疗（LCT）（≥14天）。评估的结局指标包括死亡率、复发率、与胆管炎相关的同一病原体再感染率以及住院时间。
结果
本研究共纳入44例患者：（1）SCT组19例；（2）LCT组25例。SCT组和LCT组抗菌治疗的中位疗程分别为9天[四分位数间距（IQR）：2.5 - 11.0天]和16天（IQR：15.0 - 19.0天），差异有统计学意义（<0.05）。30天死亡率、胆管炎复发率或3个月内同一病原体再感染率方面未观察到显著差异。然而，SCT组的住院时间较短（中位值：12.0天对14.0天，=0.092）。
结论
对于急性胆管炎合并GPC菌血症，在进行适当的胆道引流后，较短疗程的抗菌治疗可能是一种可行的选择。有必要开展更大样本量的进一步研究。
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