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 treatm...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.展开更多
The genus Vagococcus was first described by Collinsetal.and initially consisted of a single species,V.fluvialis.This species was isolated from chicken feces and river water and first described by Hashimoto et al.[1,2]...The genus Vagococcus was first described by Collinsetal.and initially consisted of a single species,V.fluvialis.This species was isolated from chicken feces and river water and first described by Hashimoto et al.[1,2].Teixeira et al.isolated V.fluvialis from human blood and peritoneal fluid,suggesting that it poses a potential threat to human health[3].展开更多
Background Gram-positive bacteria such as Staphylococcus aureus have been a common cause of infection among liver transplant （LT） recipients in recent decades. The understanding of local epidemiology and its evolvin...Background Gram-positive bacteria such as Staphylococcus aureus have been a common cause of infection among liver transplant （LT） recipients in recent decades. The understanding of local epidemiology and its evolving trends with regard to pathogenic spectra and antibiotic susceptibility is beneficial to prophylactic and empiric treatment for LT recipients. This study aimed to investigate etiology, timing, antibiotic susceptibility and risk factors for multidrug resistant （MDR） Gram-positive coccal bacteremia after LT.Methods A cohort analysis of prospectively recorded data was performed to investigate etiologies, timing, antibiotic susceptibility and risk factors for MDR Gram-positive coccal bacteremia in 475 LT recipients.Results In 475 LT recipients in the first six months after LT, there were a total of 98 episodes of bacteremia caused by Gram-positive cocci in 82 （17%） patients. Seventy-five （77%） bacteremic episodes occurred in the first post-LT month.The most frequent Gram-positive cocci were methicillin-resistant coagulase-negative staphylococcus （CoNS, 46 isolates）,methicillin-resistant Staphylococcus aureus （MRSA, 13） and enterococcus （34, E. faecium 30, E. faecalis 4）. In all Gram-positive bacteremic isolates, 59 of 98 （60%） were MDR. Gram-positive coccal bacteremia and MDR Gram-positive coccal bacteremia predominantly occurred in patients with acute severe exacerbation of chronic hepatitis B and with fulminant/subfulminant hepatitis. Four independent risk factors for development of bacteremia caused by MDR Gram-positive coccus were： LT candidates with encephalopathy grades Ⅱ-Ⅳ （P=0.013, OR： 16.253, 95% CI：1.822-144.995）, pre-LT use of empirical antibiotics （P=0.018, OR： 1.029, 95% CI： 1.002-1.057）, post-LT urinary tract infections （P 〈0.001, OR： 20.340, 95% CI： 4.135-100.048） and abdominal infection （P=0.004, OR： 2.820, 95% CI：1.122-10.114）. The main infectious manifestations were coinfections due to gram-positive cocci and gram-negative bacilli.Conclusions Methicillin-resistant CoNS and enterococci are predominant pathogens among LT recipients with Gram-positive coccal bacteremia. Occurrences of Gram-positive coccal bacteremia may be associated with the severity of illness in the perioperative stage.展开更多
文摘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.
基金the National Natural Science Foundation of China[Grant No.81671985]National Science and Technology Major Project of China 2018ZX10712001-007+2 种基金Science Foundation for the State Key Laboratory for Infectious Disease Prevention and Control of China[Grant number 2019SKLID403]Sanming Project of Medicine in Shenzhen[SZSM201811071]Medical Science and Technology Project of Zhejiang Province[No.2020KY400 and No.2021KY441]。
文摘The genus Vagococcus was first described by Collinsetal.and initially consisted of a single species,V.fluvialis.This species was isolated from chicken feces and river water and first described by Hashimoto et al.[1,2].Teixeira et al.isolated V.fluvialis from human blood and peritoneal fluid,suggesting that it poses a potential threat to human health[3].
文摘Background Gram-positive bacteria such as Staphylococcus aureus have been a common cause of infection among liver transplant （LT） recipients in recent decades. The understanding of local epidemiology and its evolving trends with regard to pathogenic spectra and antibiotic susceptibility is beneficial to prophylactic and empiric treatment for LT recipients. This study aimed to investigate etiology, timing, antibiotic susceptibility and risk factors for multidrug resistant （MDR） Gram-positive coccal bacteremia after LT.Methods A cohort analysis of prospectively recorded data was performed to investigate etiologies, timing, antibiotic susceptibility and risk factors for MDR Gram-positive coccal bacteremia in 475 LT recipients.Results In 475 LT recipients in the first six months after LT, there were a total of 98 episodes of bacteremia caused by Gram-positive cocci in 82 （17%） patients. Seventy-five （77%） bacteremic episodes occurred in the first post-LT month.The most frequent Gram-positive cocci were methicillin-resistant coagulase-negative staphylococcus （CoNS, 46 isolates）,methicillin-resistant Staphylococcus aureus （MRSA, 13） and enterococcus （34, E. faecium 30, E. faecalis 4）. In all Gram-positive bacteremic isolates, 59 of 98 （60%） were MDR. Gram-positive coccal bacteremia and MDR Gram-positive coccal bacteremia predominantly occurred in patients with acute severe exacerbation of chronic hepatitis B and with fulminant/subfulminant hepatitis. Four independent risk factors for development of bacteremia caused by MDR Gram-positive coccus were： LT candidates with encephalopathy grades Ⅱ-Ⅳ （P=0.013, OR： 16.253, 95% CI：1.822-144.995）, pre-LT use of empirical antibiotics （P=0.018, OR： 1.029, 95% CI： 1.002-1.057）, post-LT urinary tract infections （P 〈0.001, OR： 20.340, 95% CI： 4.135-100.048） and abdominal infection （P=0.004, OR： 2.820, 95% CI：1.122-10.114）. The main infectious manifestations were coinfections due to gram-positive cocci and gram-negative bacilli.Conclusions Methicillin-resistant CoNS and enterococci are predominant pathogens among LT recipients with Gram-positive coccal bacteremia. Occurrences of Gram-positive coccal bacteremia may be associated with the severity of illness in the perioperative stage.
