Abstract
BackgroundAntibiotics with anaerobic coverage are widely used for the treatment of biliary tract infection (BTI), even in the absence of isolated anaerobes. The current study aimed to investigate the differences in clinical outcomes in patients with community-onset bacteremic BTIs without anaerobic bacteremia, treated with vs. without anti-anaerobic coverage.MethodsA retrospective analysis was conducted at a medical center in Taiwan from September 2014 to March 2016. Patients with community-onset bacteremic BTIs without anaerobic bacteremia and who were treated with appropriate antibiotics were analyzed. The clinical outcomes were compared between patients treated with and without anti-anaerobic coverage as definitive therapy after the blood culture reports were available. Multivariable and propensity score-adjusted analysis were used to identify the risk factors associated with treatment failure.ResultsAmong the enrolled 87 patients, 63 and 24 patients were treated with and without anaerobic coverage, respectively. Escherichia coli (55.2%) and Klebsiella pneumoniae (23.0%) were the most common organisms isolated from the blood cultures. The rate of treatment failure (relapse and 28-day mortality) was similar between the groups with and without anaerobic coverage (20.6% vs. 16.7%, p = 0.677). Propensity score-adjusted multivariable analysis revealed that definitive therapy without anaerobic coverage was not a predisposing factor for treatment failure (OR = 0.92, 95% CI 0.18–4.67, p = 0.916).ConclusionsDefinitive therapy without anaerobic coverage does not affect the outcomes of patients with community-onset bacteremic BTIs without anaerobes isolated from blood. Our results might provide a possible target for antibiotic stewardship interventions in BTIs.
Highlights
Antibiotics with anaerobic coverage are widely used for the treatment of biliary tract infection (BTI), even in the absence of isolated anaerobes
In the current era of antimicrobial stewardship [11], it is essential to determine whether anaerobic coverage is necessary in bacteremic BTI patients without anaerobes isolated from blood
We aimed to investigate the differences in clinical outcomes in patients with community-onset bacteremic BTIs treated with and without anaerobic coverage as definitive therapy after the blood culture reports were available
Summary
Antibiotics with anaerobic coverage are widely used for the treatment of biliary tract infection (BTI), even in the absence of isolated anaerobes. The current study aimed to investigate the differences in clinical outcomes in patients with community-onset bacteremic BTIs without anaerobic bacteremia, treated with vs without anti-anaerobic coverage. Biliary tract infection (BTI), including cholangitis and cholecystitis, is a common cause of bacteremia, especially for patients with underlying structural abnormalities, such as choledocholithiasis or malignancy [1]. Many physicians continue to combine anti-anaerobic agents during the treatment of BTIs even when the cultures yielded no evidence of anaerobic infection. In the current era of antimicrobial stewardship [11], it is essential to determine whether anaerobic coverage is necessary in bacteremic BTI patients without anaerobes isolated from blood
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