Informations générales (source: ClinicalTrials.gov)
Is Short Antibiotherapy Duration After Drainage Suitable for Patients Admitted in Intensive Care Medicine With a Severe Acute Cholangitis? (CASCAD)
Observational
Nantes University Hospital (Voir sur ClinicalTrials)
octobre 2019
janvier 2021
29 juin 2024
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).
Etablissements
| Les établissements hors Île-de-France dont les données sont issues de ClinicalTrials.gov Origine et niveau de fiabilité des données | |||||
|---|---|---|---|---|---|
| University Hospital of Nantes - 44000 - Nantes - France | Charlotte Garret | Contact (sur clinicalTrials) | |||
Critères
Tous
Inclusion Criteria:
Adult patients (age >18 years) with acute cholangitis Admitted in Intensive care units
With a successful biliary drainage And treated with antibiotics
Adult patients (age >18 years) with acute cholangitis Admitted in Intensive care units
With a successful biliary drainage And treated with antibiotics
patients under 18 years unable to receive a drainage or inefficient drainage Patients
with a decision to limit care at the admission pregnancy