Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis

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Abstract

Antimicrobial therapy is a mainstay of the management for patients with acute cholangitis and/or cholecystitis. The Tokyo Guidelines 2018 (TG18) provides recommendations for the appropriate use of antimicrobials for community-acquired and healthcare-associated infections. The listed agents are for empirical therapy provided before the infecting isolates are identified. Antimicrobial agents are listed by class-definitions and TG18 severity grade I, II, and III subcategorized by clinical settings. In the era of emerging and increasing antimicrobial resistance, monitoring and updating local antibiograms is underscored. Prudent antimicrobial usage and early de-escalation or termination of antimicrobial therapy are now important parts of decision-making. What is new in TG18 is that the duration of antimicrobial therapy for both acute cholangitis and cholecystitis is systematically reviewed. Prophylactic antimicrobial usage for elective endoscopic retrograde cholangiopancreatography is no longer recommended and the section was deleted in TG18. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.

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Most cited references 78

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To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012".

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Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study

Karthikeyan K Kumarasamy, Mark Toleman, Timothy R. Walsh … (2010)

Summary Background Gram-negative Enterobacteriaceae with resistance to carbapenem conferred by New Delhi metallo-β-lactamase 1 (NDM-1) are potentially a major global health problem. We investigated the prevalence of NDM-1, in multidrug-resistant Enterobacteriaceae in India, Pakistan, and the UK. Methods Enterobacteriaceae isolates were studied from two major centres in India—Chennai (south India), Haryana (north India)—and those referred to the UK's national reference laboratory. Antibiotic susceptibilities were assessed, and the presence of the carbapenem resistance gene bla NDM-1 was established by PCR. Isolates were typed by pulsed-field gel electrophoresis of XbaI-restricted genomic DNA. Plasmids were analysed by S1 nuclease digestion and PCR typing. Case data for UK patients were reviewed for evidence of travel and recent admission to hospitals in India or Pakistan. Findings We identified 44 isolates with NDM-1 in Chennai, 26 in Haryana, 37 in the UK, and 73 in other sites in India and Pakistan. NDM-1 was mostly found among Escherichia coli (36) and Klebsiella pneumoniae (111), which were highly resistant to all antibiotics except to tigecycline and colistin. K pneumoniae isolates from Haryana were clonal but NDM-1 producers from the UK and Chennai were clonally diverse. Most isolates carried the NDM-1 gene on plasmids: those from UK and Chennai were readily transferable whereas those from Haryana were not conjugative. Many of the UK NDM-1 positive patients had travelled to India or Pakistan within the past year, or had links with these countries. Interpretation The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed. Funding European Union, Wellcome Trust, and Wyeth.

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Author and article information

Journal

Title: Journal of Hepato-Biliary-Pancreatic Sciences

Abbreviated Title: J Hepatobiliary Pancreat Sci

Publisher: Wiley

ISSN: 18686974

Publication date Created: January 2018

Publication date (Print): January 2018

Publication date (Electronic): January 09 2018

Volume: 25

Issue: 1

Pages: 3-16

Affiliations

[1 ]Center for Global Health; Mito Kyodo General Hospital; University of Tsukuba; Ibaraki Japan

[2 ]Department of Surgery; University of Cincinnati College of Medicine; Cincinnati OH USA

[3 ]Lewis Katz School of Medicine at Temple University; Philadelphia PA USA

[4 ]Department of Surgery; Center for Gastroenterology and Liver Disease; Kitakyushu City Yahata Hospital; Fukuoka Japan

[5 ]Department of Surgery; Teikyo University; School of Medicine; Tokyo Japan

[6 ]Section of HPB Surgery; Washington University in St. Louis; St. Louis MO USA

[7 ]Department of Family Medicine; Mie Prefectural Ichishi Hospital; Mie Japan

[8 ]Department of Gastroenterological Surgery; Yokohama City University Graduate School of Medicine; Kanagawa Japan

[9 ]Department of Gastroenterological and Pediatric Surgery; Oita University; Faculty of Medicine; Oita Japan

[10 ]Department of Surgery; Keio University School of Medicine; Tokyo Japan

[11 ]Department of Infection Control and Prevention; Teikyo University; Tokyo Japan

[12 ]Department of Internal Medicine; Teikyo University School of Medicine; Tokyo Japan

[13 ]Minimally Invasive Surgery Center; Yotsuya Medical Cube; Tokyo Japan

[14 ]Department of Surgery; Toho University Ohashi Medical Center; Tokyo Japan

[15 ]Department of Surgery; Fujinomiya City General Hospital; Shizuoka Japan

[16 ]Department of Surgery; Seoul National University Bundang Hospital; Seoul National University College of Medicine; Seoul Korea

[17 ]Division of General Surgery; Linkou Chang Gung Memorial Hospital; Taoyuan Taiwan

[18 ]Department of Surgery and Oncology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan

[19 ]Department of Surgery; Show Chwan Memorial Hospital; Changhua Taiwan

[20 ]Department of General and HPB Surgery; Loreto Nuovo Hospital; Naples Italy

[21 ]First Department of Surgery; Agia Olga Hospital; Athens Greece

[22 ]Department of General Internal Medicine; Japanese Red Cross Nagoya Daini Hospital; Aichi Japan

[23 ]Department of Gastroenterology; Ogaki Municipal Hospital; Gifu Japan

[24 ]Department of Gastroenterology and Hepatology; Tokyo Medical University Hospital; Tokyo Japan

[25 ]Department of Surgical Oncology; Lilavati Hospital and Research Centre; Mumbai India

[26 ]Clinical Surgery; University of Edinburgh; Edinburgh UK

[27 ]Department of Surgery, Hospital Italiano; University of Buenos Aires; Buenos Aires Argentina

[28 ]Mie Prefectural Ichishi Hospital; Mie Japan

[29 ]Department of Surgery; Tokyo Metropolitan Komagome Hospital; Tokyo Japan

[30 ]Department of Surgical Gastroenterology; Seth G S Medical College and K E M Hospital; Mumbai India

[31 ]Department of Hemodialysis and Surgery; Ichikawa Hospital; International University of Health and Welfare; Chiba Japan

[32 ]Department of EBM and Guidelines; Japan Council for Quality Health Care; Tokyo Japan

[33 ]Department of Emergency Medicine; School of Medicine University of Occupational and Environmental Health; Fukuoka Japan

[34 ]Department of Surgery; Academic Medical Center; Amsterdam The Netherlands

[35 ]Department of Surgery; Rush University Medical Center; Chicago IL USA

[36 ]Liau KH Consulting PL; Mt Elizabeth Novena Hospital, Singapore; Yong Loo Lin School of Medicine; National University of Singapore; Singapore

[37 ]Department of Surgery; Cheng Hsin General Hospital; Taipei Taiwan

[38 ]Surgery Centre; Department of Surgery; Hong Kong Sanatorium and Hospital; Hong Kong Hong Kong

[39 ]Department of Surgery; Yonsei University Gangnam Severance Hospital; Seoul Korea

[40 ]Department of Surgery; Konyang University Hospital; Daejeon Korea

[41 ]Surgical Gastroenterology/Hepatopancreatobiliary Unit; University of Cape Town and Groote Schuur Hospital; Cape Town South Africa

[42 ]Hepatic Surgery Centre; Department of Surgery; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China

[43 ]Liver Surgery Centre; Hong Kong Sanatorium and Hospital; Hong Kong Hong Kong

[44 ]Department of Surgery; Yuan's General Hospital; Kaohsiung Taiwan

[45 ]Chair of General Surgery and Minimal Invasive Surgery “Taquini”; University of Buenos Aires, Argentina; DAICIM Foundation; Buenos Aires Argentina

[46 ]Oita University; Oita Japan

[47 ]Department of Surgery; Institute of Gastroenterology; Tokyo Women's Medical University; Tokyo Japan

[48 ]Department of Surgery; JR Sapporo Hospital; Hokkaido Japan

[49 ]Department of Gastroenterology; Second Teaching Hospital; Fujita Health University; Aichi Japan

[50 ]Toho University; Tokyo Japan