Is Short Antibiotherapy Duration After Drainage Suitable for Patients Admitted in Intensive Care Medicine With a Severe Acute Cholangitis?
Is Short Antibiotherapy Duration After Drainage Suitable for Patients Admitted in Intensive Care Medicine With a Severe Acute Cholangitis?
Acute cholangitis (AC) occurs when biliary stenosis, due to various benign causes (often
 gallstones) or the presence of a tumour, leads to cholestasis and biliary infection. AC is a
 life-threatening infection if not diagnosed and treated in time, its mortality ranges from
 1.4% to 5.2%. AC can be classified into different stages of severity depending on organ
 failure. A severity classification has been proposed by the Asian recommendations of Tokyo
 2013: Grade I (Benin), Grade II (Moderate) and Grade III (Severe).

 AC treatment includes endoscopic or percutaneous bile drainage in combination with systemic
 antibiotic treatment. It is currently recommended that patients with severe CA (Grade III)
 have biliary drainage within 24 hours, although it has not been shown to improve their
 survival. The emergence of antibiotic-resistant germs, which is a public health issue, calls
 for reasonable and considered use of antibiotics. Reducing the duration of antibiotic therapy
 is a fundamental measure of antimicrobial management and antibiotics sparing. 7 to 10 days of
 antibiotic treatment is common in the treatment of CA. A 14-day treatment is recommended in
 case of associated bacteremia. A recent study of 263 patients showed that reducing the
 duration of antibiotic therapy to less than 7 days in patients with CA associated with
 bacteremia with effective drainage does not increase the risk of recurrence or mortality at
 30 days. However, this study was monocentric retrospective and compared groups that were
 unbalanced in terms of CA severity. The optimal duration of antibiotic therapy in the
 treatment of CA in critically ill patients hospitalized in intensive care remains poorly
 known.

 The main purpose of this study is to compare short antibiotic therapy with long antibiotic
 therapy in terms of mortality in patients with AC admitted in intensive care unit (ICU).
Using electronic patient data monitoring systems, the investigators reviewed all patients
 with a diagnosis of AC admitted to digestive liver disease unity or ICUs at the Nantes
 University Hospital, Rennes University Hospital from January 1, 2006, to december 31, 2018.
 For enrolled patients, general clinical characteristics were collected. Patients were
 categorized into two groups according to antibiotics duration, and the differences of these
 characteristics between two groups were evaluated.
Inclusion Criteria:

 Adult patients (age >18 years) with acute cholangitis Admitted in Intensive care units With
 a successful biliary drainage And treated with antibiotics

 Exclusion Criteria:

 patients under 18 years unable to receive a drainage or inefficient drainage Patients with
 a decision to limit care at the admission pregnancy