title: Impact of inadequate initial antimicrobial therapy on mortality in patients with bacteraemic cholangitis: a retrospective cohort study.
abstract: OBJECTIVE
  Acute cholangitis is a common cause of bacteraemia resulting in severe sepsis or septic shock. The impact of the appropriate initial antimicrobial therapy on short-term mortality in bacteraemic cholangitis has not been well investigated.
  
  
  METHODS
  We conducted a retrospective cohort study of patients with bacteraemic cholangitis at two large tertiary care centres in Tokyo, Japan between 2009 and 2015. We determined the factors associated with 30-day all-cause mortality from the date of drawing the first positive blood culture, using a multivariate logistic regression analysis.
  
  
  RESULTS
  We identified 573 patients with bacteraemic cholangitis (median age, 77 years; male, 58.3%). The 30-day all-cause mortality rate was 6.6% (38/573). Inadequate initial antimicrobial therapy occurred in 133 (23.2%) patients. Factors associated with 30-day all-cause mortality included the Charlson co-morbidity index score >3 (adjusted odds ratio (aOR) 4.12; 95% CI 1.18-14.38), jaundice (total bilirubin >2.5 mg/dL) (aOR 3.39; 95% CI 1.46-7.89), septic shock within 48 h of the first positive blood culture (aOR 3.34; 95% CI 1.42-7.89), biliary obstruction due to hepatobiliary malignancy (aOR 8.00; 95% CI 2.92-21.97), and inadequate initial antimicrobial therapy (aOR 2.78; 95% CI 1.27-6.11).
  
  
  CONCLUSIONS
  Inadequate initial antimicrobial therapy was an important, modifiable determinant of survival.
authors.affiliation: Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan; Department of Infection Control Science, Juntendo University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Tagashira
authors.affiliation: Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Sakamoto
authors.affiliation: Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Isogai
authors.affiliation: Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Hikone
authors.affiliation: Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Kosaka
authors.affiliation: Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Chino
authors.affiliation: Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Higuchi
authors.affiliation: Department of Infection Control Science, Juntendo University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Uehara
authors.affiliation: Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan. Electronic address: hondah@hotmail.com.
authors.forename: H
authors.initials: H
authors.lastname: Honda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000401:mortality*; D002761:Cholangitis / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D062606:Tertiary Care Centers; D014041:Tokyo
chemical_list: D000890:Anti-Infective Agents
keywords: Bacteraemic cholangitis; Inadequate antimicrobial therapy; Mortality; Outcome; Treatment