Comparison between short-course and long-course antimicrobial treatments for acute cholangitis with gram-positive coccus bacteremia after endoscopic retrograde cholangiopancreatography

Table 1 Patient characteristics, n (%)

Characteristics	Short-course treatment (< 14 days) (n = 19)	Long-course treatment (≥ 14 days) (n = 25)	P value
Age (median, IQR)	78.0 (71.0-85.0)	75.0 (69.0-84.0)	0.667
Sex (male)	13 (68.4)	14 (56.0)	0.599
Co-morbidities
Cerebrovascular disease	4 (21.1)	6 (24.0)	1.000
Chronic pulmonary disease	4 (21.1)	6 (24.0)	1.000
Congestive heart failure	2 (10.5)	3 (12.0)	1.000
Chronic liver disease	1 (5.3)	3 (12.0)	0.622
Chronic kidney disease (serum creatinine > 1.5 mg/dL)	2 (10.5)	4 (16.0)	0.684
Diabetes mellitus	9 (47.4)	9 (36.0)	0.653
Rheumatic disease	1 (5.3)	0 (0)	0.432
Malignancy	1 (5.3)	4 (16.0)	0.370
Charlson Comorbidity Index (median, IQR)	5.0 (4.5-7.0)	6.0 (4.0-8.0)	0.839
Use of other immunosuppressive agents or chemotherapy	0 (0)	1 (4.0)	1.000
Use of glucocorticoids	0 (0)	2 (8.0)	0.498
Tokyo Guideline 18 severity grading			0.924
Grade Ⅰ	7 (36.8)	9 (36.0)
Grade Ⅱ	4 (21.1)	4 (16.0)
Grade Ⅲ	8 (42.1)	12 (48.0)
Quick Sepsis-Related Organ Failure Assessments (median, range)	1 (0-3)	2 (0-3)	0.149
intensive care unit admission	3 (15.8)	7 (28.0)	0.474
Use of vasopressor	2 (10.5)	8 (32.0)	0.148
White blood cells at diagnosis (/mm3) (mean, range)	9620 (2800-22900)	12220 (3500-33100)	0.217
C-reactive protein at diagnosis (mg/dL) (mean, range)	7.09 (0.04-23.5)	7.01 (0.05-29.0)	0.915
Total bilirubin at diagnosis (mg/dL, mean, range)	3.36 (1.0-7.4)	3.18 (0.5-11.0)	0.633
Body temperature (°C) (mean, range)	37.9 (36.7-39.7)	38.3 (36.6-40.7)	0.229
Cause			0.691
Stone	16 (84.2)	20 (80.0)
Diverticulum	1 (5.3)	3 (12.0)
Stent obstruction	1 (5.3)	2 (8.0)
Others	1 (5.3)	0 (0)
Acute cholecystitis	9 (47.4)	9 (36.0)	0.653
Acute pancreatitis	5 (26.3)	3 (12.0)	0.262
Heart valve disease	7 (36.8)	8 (32.0)	0.988
Nosocomial onset	1 (5.3)	2 (8.0)	1.000
Intravascular devices	2 (10.5)	2 (8.0)	1.000
Auscultation of murmur			0.844
Yes	3 (16.7)	2 (8.7)
No	15 (83.3)	21 (91.3)
Persistent fever for 7 days or more	0 (0)	0 (0)
Echocardiography	7 (36.8)	18 (72.0)	0.042
Number of positive blood culture			0.005
1	13 (68.4)	6 (24.0)
2	6 (31.6)	19 (76.0)
Follow-up of blood culture			1.000
Positive	0 (0)	0 (0)
Negative	4 (100)	13 (100)
Causative organism
Polymicrobial	15 (79.0)	17 (68.0)	0.507
Enterococcus sp.	13 (68.4)	16 (64.0)	1.000
Enterococcus faecalis	4 (21.1)	3 (12.0)	0.443
Enterococcus faecium	3 (15.8)	2 (8.0)	0.638
Streptococcus sp.	6 (31.6)	8 (32.0)	1.000
Others	1 (5.3)	2 (8.0)	1.000
Antibiotics
Penicillin	9 (47.4)	23 (92.0)	0.002
Cephalosporin	13 (68.4)	16 (64.0)	1.000
Carbapenem	2 (10.5)	4 (16.0)	0.684
Clindamycin	8 (42.1)	7 (28.0)	0.511
Glycopeptide	2 (10.5)	11 (44.0)	0.021
Fluoroquinolone	5 (26.3)	7 (28.0)	1.000
Linezolid	1 (5.3)	0 (0)	0.432
Metronidazole	2 (10.5)	1 (4.0)	0.570
Aminoglycoside	1 (5.3)	0 (0)	0.432
Time to drainage			0.710
≤ 24 hours	15 (78.9)	21 (84.0)
> 24 hours	4 (21.1)	4 (16.0)
Duration of effective antibiotics days (median, IQR)	9.0 (2.5-11.0)	16.0 (15.0-19.0)	< 0.001
Duration of effective intravenous antibiotics days (median, IQR)	8.0 (0.0-10.0)	12.0 (8.0-16.0)	0.001

IQR: Interquartile range.

Table 2 Outcomes between short-course and long-course antimicrobial treatment groups, n (%)

Outcomes	Short-course treatment (< 14 days) (n = 19)	Long-course treatment (≥ 14 days) (n = 25)	P value
30-day mortality	0 (0)	0 (0)
Recurrence of cholangitis within 3 months			1.000
Yes	1 (5.3)	2 (8.0)
No	18 (94.7)	23 (92.0)
Reinfection with the same organism within 3 months	0 (0)	0 (0)
Length of hospital stay (median, interquartile range)	12.0 (7.5-13.0)	14.0 (9.0-18.0)	0.092