Introduction
Acute cholangitis is an important cause of mortality and morbidity, especially in elderly patients and those with multiple comorbidities. However, the appropriate duration of antibiotic therapy after biliary drainage remains controversial. The aim of this study is to evaluate the efficacy of a short versus a long course of antibiotics after biliary drainage in patients with acute cholangitis.
Aims & Methods
Retrospective analytical cohort study of patients with acute cholangitis treated at a fourth level hospital in Bogotá, Colombia, from 2014 to 2022. Short antibiotic therapy was defined as ≤ 4 days after successful post-ERCP drainage. The primary outcome was a composite of in-hospital mortality, ICU admission, and hospital readmission 30 days after discharge. A univariate and multivariate logistic regression model was performed to assess the association between duration of antibiotic therapy and the primary composite outcome.
Results
317 patients were included. E. coli was the most commonly isolated microorganism regardless of severity, and 54% proved 100% antimicrobial susceptibility. 59 patients received short therapy and 258 received long therapy. There were no statistically significant differences in the primary outcome (p=1), but a longer hospital stay was observed in the long-term treatment group (p<0.001). The presence of Tokyo III severity and carbapenem resistance were risk factors for the primary outcome (OR 32.07; 95% CI 11.84-113.16, p<0.001) and (OR 4.07; 95% CI 1.02-16.96, p=0.04) respectively.
Univariate and multivariate analysis of clinical factors associated with mortality, ICU admission or hospital readmission at 30 days in patients with acute cholangitis undergoing ERCP
| Univariate analysis | Multivariate analysis |
| Variable | OR (CI 95%) | p value | OR (CI 95%) | p value |
| SCT | 1.73 (0.76-3.89) | 0.18 | - | - |
| Oncological pathology | 1.51 (0.47-4.87) | 0.48 | 1.77 (0.96-3.29) | 0.06 |
| Previous antibiotic use* | 0.66 (0.15 -2.87) | 0.57 | - | - |
| Previous hospitalization* | 0.86 (0.19-3.51) | 0.84 | - | - |
Etiology
|
Reference
0.80 (0.25-2.6) |
Ref
0.70 | -
- | -
- |
Severity (Tokyo score)
I
II
III |
Reference
2.72 (0.96-9.77)
30.67 (10.57-113.97) |
Ref
0.08
<0.001 |
2.70 (0.98-9.54)
32.07 (11.84 113.16) |
0.07
<0.001 |
| Bacteremia | 1.34 (0.68-2.59) | 0.38 | - | - |
| Carbapenem resistance | 5.21 (1.24-23.66) | 0.02 | 4.07 (1.02-16.96) | 0.04 |
*In the three months prior to the index hospitalization. SCT: Short course therapy; OR: Odds Ratio, 95% CI: 95% Confidence Interval
Conclusion
Shorter courses of antibiotics after ERCP drainage can be considered a therapeutic option for patients with acute cholangitis. However, the methodological limitations of this study should be considered.
References
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Disclosure
Nothing to disclose