title: Short-course antimicrobial treatment for acute cholangitis with Gram-negative bacillary bacteremia.
abstract: OBJECTIVE
  The optimal antimicrobial treatment duration for patients with acute cholangitis with bacteremia remains unknown. The updated Tokyo Guidelines 2013 recommend a minimum duration of 2 weeks only when bacteremia with Gram-positive cocci is present. Since May 2013, a shorter antimicrobial treatment duration of under 2 weeks has been implemented at the authors' institution for acute cholangitis with Gram-negative bacillary bacteremia. The aim of the present study was to validate this modified practice.
  
  
  METHODS
  A single-center retrospective cohort study was conducted. The antimicrobial treatment duration, 30-day mortality rate, and recurrence rate within 3 months were compared between patients treated before May 2013 and after May 2013.
  
  
  RESULTS
  Ninety-one patients with cholangitis with bacteremia were analyzed. The median antimicrobial treatment duration was 14.5days in patients treated before May 2013 and 10.0days after May 2013 (p <0.001). While the 30-day mortality rate did not differ significantly, the recurrence rate was higher in those treated before May 2013 (5.7% vs. 0.0%, p=0.17 and 13.3% vs. 0.0%, p=0.03, respectively). The median treatment duration after May 2013 was 8days for grade I patients, 10days for grade II patients, and 11.5days for grade III patients.
  
  
  CONCLUSIONS
  The results of this study suggest that acute cholangitis with Gram-negative bacillary bacteremia can be treated safely with a shorter antimicrobial treatment duration of <14 days.
authors.affiliation: Center for Infectious Diseases and Infection Control, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan. Electronic address: br.op45@gmail.com.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Uno
authors.affiliation: Department of Infectious Diseases, Kameda Medical Center, Kamogawa, Chiba, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Hase
authors.affiliation: Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan.
authors.forename: Toshiyasu
authors.initials: T
authors.lastname: Shiratori
authors.affiliation: Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan.
authors.forename: So
authors.initials: S
authors.lastname: Nakaji
authors.affiliation: Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan.
authors.forename: Nobuto
authors.initials: N
authors.lastname: Hirata
authors.affiliation: Department of Infectious Diseases, Kameda Medical Center, Kamogawa, Chiba, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Hosokawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D002761:Cholangitis / Q000188:drug therapy* / Q000382:microbiology; D015331:Cohort Studies; D005260:Female; D006090:Gram-Negative Bacteria; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014041:Tokyo
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents
keywords: Acute cholangitis; Antimicrobial stewardship; Bacteremia; Drainage