Addition of anaerobic coverage for treatment of biliary tract infections: a propensity score-matched cohort study

Abstract

Objectives To evaluate whether additional antibiotics that target anaerobes, including Bacteroides spp., are associated with improved clinical outcomes in patients with biliary tract infections (BTIs). Methods This was a retrospective propensity score-matched cohort of adults aged ≥18 years with BTIs, admitted to hospital between 1 April 2015 and 30 March 2021. Eligible patients treated with antibiotics that provided coverage of anaerobes were compared with those treated with comparable regimens without anaerobic coverage. The primary outcome was a composite of mortality within 30 days or relapse within 90 days of source control or completion of antibiotics. Secondary outcomes included length of stay (LOS), duration of antibiotic therapy and adverse drug reactions. ORs were calculated using a weighted generalized linear regression model with propensity-score matching. Results Among 398 patients included, 209 were treated without anaerobic coverage and 189 with anaerobic coverage. After propensity-score matching, there was no significant difference in primary outcome between propensity-matched patients who received additional anaerobic coverage and those who did not [adjusted OR (aOR) 1.23; 95% CI 0.69–2.22)]. Those with anti-anaerobic coverage had longer LOS (aOR 4.85; 95% CI 1.68–13.98) and longer duration of antibiotic treatment (aOR 4.14; 95% CI 2.61–6.57) than those who did not receive additional anaerobic therapy, but not more adverse drug reactions (aOR 1.01; 95% CI 0.97–1.05). Conclusions Omitting anti-anaerobic antibiotics may be a safe antimicrobial stewardship intervention. However, a randomized controlled trial may be warranted to definitively conclude whether additional anaerobic coverage in BTI treatment is necessary.

Antimicrobial therapy outcomes in acute cholangitis: Hilar multiple obstructions versus single hilar and common bile duct obstructions

“…Clinical cure was defined as the absence of initial presenting symptoms by day 14 after biliary drainage, coupled with no recurrence or death by day 30 24,25 . Recurrence was defined as the initiation of a new antibiotic therapy for recurrent cholangitis, subsequent infection in the hepatic–pancreatic–biliary region, or any other subsequent infection possibly related to the initial episode of cholangitis 5,26,27 …”

“…24,25 Recurrence was defined as the initiation of a new antibiotic therapy for recurrent cholangitis, subsequent infection in the hepatic-pancreatic-biliary region, or any other subsequent infection possibly related to the initial episode of cholangitis. 5,26,27 Statistical analysis. The three groups were classified based on the duration of antibiotic use after ERCP, and blood culture results were compared using univariate analysis.…”

“…24 , 25 Recurrence was defined as the initiation of a new antibiotic therapy for recurrent cholangitis, subsequent infection in the hepatic–pancreatic–biliary region, or any other subsequent infection possibly related to the initial episode of cholangitis. 5 , 26 , 27 …”

The clinical significance of anaerobic coverage in the antibiotic treatment of aspiration pneumonia: a systematic review and meta-analysis

“…As a result of these changes, it cannot be assumed that the optimal routine antibiotic treatment for aspiration pneumonia is to cover anaerobes. There is evidence that the routine usage of anaerobic coverage may not only be non-beneficial, but also potentially harmful [12,13]. The unnecessary use of broad-spectrum antibiotics must be avoided in view of future resistance, adverse effects and healthcare costs.…”