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Fico V, La Greca A, Tropeano G, Di Grezia M, Chiarello MM, Brisinda G, Sganga G. Updates on Antibiotic Regimens in Acute Cholecystitis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1040. [PMID: 39064469 PMCID: PMC11279103 DOI: 10.3390/medicina60071040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/18/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024]
Abstract
Acute cholecystitis is one of the most common surgical diseases, which may progress from mild to severe cases. When combined with bacteremia, the mortality rate of acute cholecystitis reaches up to 10-20%. The standard of care in patients with acute cholecystitis is early laparoscopic cholecystectomy. Percutaneous cholecystostomy or endoscopic procedures are alternative treatments in selective cases. Nevertheless, antibiotic therapy plays a key role in preventing surgical complications and limiting the systemic inflammatory response, especially in patients with moderate to severe cholecystitis. Patients with acute cholecystitis have a bile bacterial colonization rate of 35-60%. The most frequently isolated microorganisms are Escherichia coli, Klebsiella spp., Streptococcus spp., Enterococcus spp., and Clostridium spp. Early empirical antimicrobial therapy along with source control of infection is the cornerstone for a successful treatment. In these cases, the choice of antibiotic must be made considering some factors (e.g., the severity of the clinical manifestations, the onset of the infection if acquired in hospital or in the community, the penetration of the drug into the bile, and any drug resistance). Furthermore, therapy must be modified based on bile cultures in cases of severe cholecystitis. Antibiotic stewardship is the key to the correct management of bile-related infections. It is necessary to be aware of the appropriate therapeutic scheme and its precise duration. The appropriate use of antibiotic agents is crucial and should be integrated into good clinical practice and standards of care.
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Affiliation(s)
- Valeria Fico
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Istituto di Ricerca e Cura a Carattere Scientifico, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy; (V.F.); (A.L.G.); (G.T.); (M.D.G.); (G.S.)
| | - Antonio La Greca
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Istituto di Ricerca e Cura a Carattere Scientifico, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy; (V.F.); (A.L.G.); (G.T.); (M.D.G.); (G.S.)
- Catholic School of Medicine “Agostino Gemelli”, 00168 Rome, Italy
| | - Giuseppe Tropeano
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Istituto di Ricerca e Cura a Carattere Scientifico, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy; (V.F.); (A.L.G.); (G.T.); (M.D.G.); (G.S.)
| | - Marta Di Grezia
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Istituto di Ricerca e Cura a Carattere Scientifico, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy; (V.F.); (A.L.G.); (G.T.); (M.D.G.); (G.S.)
| | - Maria Michela Chiarello
- General Surgery Operative Unit, Department of Surgery, Azienda Sanitaria Provinciale Cosenza, 87100 Cosenza, Italy;
| | - Giuseppe Brisinda
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Istituto di Ricerca e Cura a Carattere Scientifico, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy; (V.F.); (A.L.G.); (G.T.); (M.D.G.); (G.S.)
- Catholic School of Medicine “Agostino Gemelli”, 00168 Rome, Italy
| | - Gabriele Sganga
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Istituto di Ricerca e Cura a Carattere Scientifico, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy; (V.F.); (A.L.G.); (G.T.); (M.D.G.); (G.S.)
- Catholic School of Medicine “Agostino Gemelli”, 00168 Rome, Italy
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Cao JH, Mu ZH, Li HM, Li GX, Chen J, Yao JJ, Yang XW, Wang S. Utility of enteral nutrition via percutaneous transhepatic cholangiography drainage catheterization in late-stage malignant obstructive jaundice. Scand J Gastroenterol 2024; 59:570-576. [PMID: 38252748 DOI: 10.1080/00365521.2024.2305274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024]
Abstract
Objective: The purpose of this study was to explore the clinical benefits of establishing an enteral nutrition (EN) pathway via percutaneous transhepatic cholangiography drainage (PTCD) catheterization in patients with late-stage malignant obstructive jaundice (MOJ).Methods: We selected 30 patients diagnosed as having late-stage MOJ with malnutrition. A dual-lumen biliary-enteral nutrition tube was placed via PTCD along with a biliary stent implantation. Postoperative EN was provided, and we observed the time taken for tube placement, its success rate, complications, and therapeutic efficacy.Results: Tube placement was successful in all 30 patients with an average procedural time of 5.7 ± 1.4 min with no tube placement complications. Compared to preoperative measures, there was a significant improvement in postoperative jaundice reduction and nutritional indicators one month after the procedure (p < 0.05). Post-placement complications included tube perileakage in 5 cases, entero-biliary reflux in 4 cases, tube blockage in 6 cases, tube displacement in 4 cases, accidental tube removal in 3 cases, and tube replacement due to degradation in 8 cases, with tube retention time ranging from 42 to 314 days, averaging 124.7 ± 37.5 days. All patients achieved the parameters for effective home-based enteral nutrition with a noticeable improvement in their quality of life.Conclusion: In this study, we found that the technique of establishing an EN pathway via PTCD catheterization was minimally invasive, safe, and effective; the tube was easy to maintain; and patient compliance was high. It is, thus, suitable for long-term tube retention in patients with late-stage MOJ.
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Affiliation(s)
- Jian-Hua Cao
- Department of Hepatobiliary Surgery, The First People's Hospital of Yinchuan, Ningxia, China
| | - Zhan-Hu Mu
- Department of Hepatobiliary Surgery, The First People's Hospital of Yinchuan, Ningxia, China
| | - Hai-Ming Li
- Department of Hepatobiliary Surgery, The First People's Hospital of Yinchuan, Ningxia, China
| | - Gao-Xiang Li
- Department of Hepatobiliary Surgery, The First People's Hospital of Yinchuan, Ningxia, China
| | - Jie Chen
- Department of Hepatobiliary Surgery, The First People's Hospital of Yinchuan, Ningxia, China
| | - Jian-Jun Yao
- Department of Hepatobiliary Surgery, The First People's Hospital of Yinchuan, Ningxia, China
| | - Xue-Wen Yang
- Department of Ultrasonography, The First People's Hospital of Yinchuan, Ningxia, China
| | - Sheng Wang
- Department of Hepatobiliary Surgery, The First People's Hospital of Yinchuan, Ningxia, China
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Jung HM, Paik J, Lee M, Kim YW, Kim TY. Clinical Utility of the Tokyo Guidelines 2018 for Acute Cholangitis in the Emergency Department and Comparison with Novel Markers (Neutrophil-to-Lymphocyte and Blood Nitrogen Urea-to-Albumin Ratios). J Clin Med 2024; 13:2306. [PMID: 38673579 PMCID: PMC11051285 DOI: 10.3390/jcm13082306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/12/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
Introduction: The Tokyo Guidelines 2018 (TG2018) is a scoring system used to recommend the clinical management of AC. However, such a scoring system must incorporate a variety of clinical outcomes of acute cholangitis (AC). In an emergency department (ED)-based setting, where efficiency and practicality are highly desired, clinicians may find the application of various parameters challenging. The neutrophil-to-lymphocyte ratio (NLR) and blood urea nitrogen-to-albumin ratio (BAR) are relatively common biomarkers used to assess disease severity. This study evaluated the potential value of TG2018 scores measured in an ED to predict a variety of clinical outcomes. Furthermore, the study also compared TG2018 scores with NLR and BAR scores to demonstrate their usefulness. Methods: This retrospective observational study was performed in an ED. In total, 502 patients with AC visited the ED between January 2016 and December 2021. The primary endpoint was to evaluate whether the TG2018 scoring system measured in the ED was a predictor of intensive care, long-term hospital stays (≥14 days), percutaneous transhepatic biliary drainage (PTBD) during admission care, and endotracheal intubation (ETI). Results: The analysis included 81 patients requiring intensive care, 111 requiring long-term hospital stays (≥14 days), 49 requiring PTBD during hospitalization, and 14 requiring ETI during hospitalization. For the TG2018 score, the adjusted OR (aOR) using (1) as a reference was 23.169 (95% CI: 9.788-54.844) for (3) compared to (1). The AUC of the TG2018 for the need for intensive care was 0.850 (95% CI: 0.815-0.881) with a cutoff of >2. The AUC for long-term hospital stays did not exceed 0.7 for any of the markers. the AUC for PTBD also did not exceed 0.7 for any of the markers. The AUC for ETI was the highest for BAR at 0.870 (95% CI: 0.837-0.899) with a cutoff value of >5.2. Conclusions: The TG2018 score measured in the ED helps predict various clinical outcomes of AC. Other novel markers such as BAR and NLR are also associated, but their explanatory power is weak.
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Affiliation(s)
- Hyun-Min Jung
- Department of Emergency Medicine, Inha University Hospital, College of Medicine, Inha University, 27, Inhang-ro, Jung-gu, Incheon 22332, Republic of Korea; (H.-M.J.); (J.P.)
| | - Jinhui Paik
- Department of Emergency Medicine, Inha University Hospital, College of Medicine, Inha University, 27, Inhang-ro, Jung-gu, Incheon 22332, Republic of Korea; (H.-M.J.); (J.P.)
| | - Minsik Lee
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang 10326, Republic of Korea; (M.L.); (Y.W.K.)
| | - Yong Won Kim
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang 10326, Republic of Korea; (M.L.); (Y.W.K.)
| | - Tae-Youn Kim
- Department of Emergency Medicine, Inha University Hospital, College of Medicine, Inha University, 27, Inhang-ro, Jung-gu, Incheon 22332, Republic of Korea; (H.-M.J.); (J.P.)
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Nitsa Z, Mulita F, Sotiropoulou M, Panagakis A, Despotidis M, Karydakis L, Schizas D, Vailas M. Intrahepatic aneurysm in a branch of the right hepatic artery in a patient with vasculitis due to systemic lupus erythematosus. PRZEGLAD GASTROENTEROLOGICZNY 2024; 19:214-216. [PMID: 38939057 PMCID: PMC11200073 DOI: 10.5114/pg.2024.136247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/08/2024] [Indexed: 06/29/2024]
Affiliation(s)
- Zoi Nitsa
- Upper Gastrointestinal and General Surgery Unit, First Department of Surgery, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Maria Sotiropoulou
- Third Surgical Department, Evangelismos General Hospital, Athens, Greece
| | - Andreas Panagakis
- Upper Gastrointestinal and General Surgery Unit, First Department of Surgery, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Markos Despotidis
- Upper Gastrointestinal and General Surgery Unit, First Department of Surgery, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Lysandros Karydakis
- Upper Gastrointestinal and General Surgery Unit, First Department of Surgery, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Dimitrios Schizas
- Upper Gastrointestinal and General Surgery Unit, First Department of Surgery, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Michail Vailas
- Upper Gastrointestinal and General Surgery Unit, First Department of Surgery, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
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Lee TY, Lee SH, Cheon YK, Wang JH. The Comparison of Clinical Outcomes in Elderly (≥75 Years) and Non-Elderly (<75 Years) Patients with Acute Cholangitis Due to Choledocholithiasis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2171. [PMID: 38138274 PMCID: PMC10744703 DOI: 10.3390/medicina59122171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Acute cholangitis may be fatal, particularly in elderly patients. According to the Tokyo Guidelines 2018, those aged ≥75 years are classified as moderate (Grade II) severity. However, it has not been established whether age itself is the deciding factor of poor outcomes. We studied the impact of old age (≥75 years) on the mortality and morbidity of acute cholangitis due to choledocholithiasis. Materials and Methods: We retrospectively examined 260 patients with calculous acute cholangitis who had undergone biliary drainage. Patients were divided into two groups: elderly (≥75 years) and non-elderly (<75 years). We aimed to compare organ dysfunction, in-hospital mortality, intensive care unit (ICU) hospitalization, and the severity of acute cholangitis. Results: Of 260 patients, 134 (51.5%) were in the elderly group and 126 (48.5%) were in the non-elderly group. The mean age was 72.3 ± 14.4 years, and 152 (58.5%) were men. The elderly patients showed a higher incidence of shock (12.7% vs. 4.8%, p = 0.029), respiratory dysfunction (7.5% vs. 0%, p = 0.002), and renal dysfunction (8.2% vs. 0.8%, p = 0.006) than the non-elderly patients. The overall in-hospital mortality rate was 2.7%, with no significant differences between the elderly and the non-elderly (4.5% vs. 0.8%, p = 0.121). The incidence of severe acute cholangitis was significantly higher in the elderly group (26.9% vs. 9.5%, p < 0.001). However, there was no significant difference in the rates of ICU hospitalization (9.7% vs. 4%, p = 0.088) and lengths of hospital stay (LOS) (8.3 d vs. 7.1 d, p = 0.086). Conclusions: No difference was observed in the in-hospital mortality, ICU hospitalization, or LOS between the elderly (≥75 years) and the non-elderly (<75 years) with calculous acute cholangitis. However, severe acute cholangitis was significantly more frequent in elderly patients.
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Affiliation(s)
- Tae-Yoon Lee
- Department of Internal Medicine, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 05030, Republic of Korea; (T.-Y.L.); (S.-H.L.); (Y.-K.C.)
| | - Sang-Hoon Lee
- Department of Internal Medicine, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 05030, Republic of Korea; (T.-Y.L.); (S.-H.L.); (Y.-K.C.)
| | - Young-Koog Cheon
- Department of Internal Medicine, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 05030, Republic of Korea; (T.-Y.L.); (S.-H.L.); (Y.-K.C.)
| | - Joon-Ho Wang
- Department of Internal Medicine, Konkuk University Chungju Hospital, Konkuk University School of Medicine, Chungju 27376, Republic of Korea
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