Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 27, 2025; 17(6): 108100
Published online Jun 27, 2025. doi: 10.4254/wjh.v17.i6.108100
Comparison between short-course and long-course antimicrobial treatments for acute cholangitis with gram-positive coccus bacteremia after endoscopic retrograde cholangiopancreatography
Yuntae Kim, Kazuhiro Ishikawa, Kenji Nakamura, Hikaru Ikusaka, Ryohsuke Yokosuka, Tomohiro Yamazaki, Yuichiro Suzuki, Shuhei Okuyama, Koichi Takagi, Katsuyuki Fukuda
Yuntae Kim, Hikaru Ikusaka, Ryohsuke Yokosuka, Tomohiro Yamazaki, Yuichiro Suzuki, Shuhei Okuyama, Koichi Takagi, Katsuyuki Fukuda, Department of Gastroenterology, St. Luke's International Hospital, Tokyo 104-8560, Japan
Kazuhiro Ishikawa, Department of Infectious Diseases, St. Luke's International Hospital, Tokyo 104-8560, Japan
Kenji Nakamura, Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, Chiba 272-0824, Japan
Author contributions: Kim Y analyzed the data and wrote the manuscript; Kim Y and Ishikawa K designed and performed the research; all authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the Institutional Review Board of St. Luke’s International Hospital (No. 24-R014). All procedures were conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments.
Informed consent statement: Informed consent was obtained using an opt-out approach, as approved by the Institutional Review Board of St. Luke’s International Hospital. Information regarding the study was made publicly available, and patients were given the opportunity to decline participation.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The data that support the findings of this study may be available from the corresponding author upon reasonable request and with permission from St. Luke’s International Hospital.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yuntae Kim, MD, Department of Gastroenterology, St. Luke's International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo 104-8560, Japan. yunte.soccer.05@gmail.com
Received: April 7, 2025
Revised: April 24, 2025
Accepted: May 26, 2025
Published online: June 27, 2025
Processing time: 81 Days and 23.6 Hours
Abstract
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 (P < 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 vs 14.0 days, P = 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.

Keywords: Acute cholangitis; Antibiotic; Short-course; Long-course; Antimicrobial; Treatment duration; Gram-positive coccus bacteremia; Endoscopic retrograde cholangiopancreatography

Core Tip: The optimal duration of antimicrobial treatment for acute cholangitis with gram-positive coccus bacteremia has not been well investigated. The Tokyo Guidelines 2018 recommended at least 14 days of treatment, citing the potential risk of infective endocarditis. However, the actual risk appears to be low, and a discrepancy with real-world practice has therefore been proposed. This study evaluated mortality, relapse, reinfection with the same organism, and length of hospital stay between the short-course treatment (SCT) and long-course treatment groups. No significant differences were observed in the treatment outcomes; however, the length of hospital stay tended to be shorter in the SCT group.