meropenem and Cholangitis

Pantoea is a Gram-negative, non-encapsulated, non-spore-forming, ubiquitous straight rod which can be isolated from geographical and ecological sources such as plant surfaces, buckwheat seeds, human feces, and the environment. The genus Pantoea is a rare pathogen in a clinical setting, and is divided into 20 different species such as Pantoea agglomerans, Pantoea ananatis, Pantoea deleyi, Pantoea dispersa, Pantoea septica, Pantoea stewartii or Pantoea rwandensis. Pantoea dispersa has been reported to cause other infections, including respiratory infections, neonatal sepsis, and bloodstream infections. We report a case of Pantoea dispersa bacteremia caused by acute cholangitis. This is the first case report of Pantoea dispersa bacteremia caused by acute cholangitis as far as we had searched.. A 38-year-old Japanese woman suffered from acute cholangitis; a blood culture showed that Gram-negative rod was positive. The treatment was successful with intravenously administered meropenem, and it was switched to orally administered levofloxacin according to microbiological susceptibility. The organism was identified as Pantoea dispersa by both genetic investigation by 16S ribosomal RNA and additional biochemical tests. To the best of our knowledge, this is the first case report of Pantoea dispersa bacteremia caused by acute cholangitis.. The epidemiology and clinical features of Pantoea dispersa are still unknown. More cases of infections caused by Pantoea dispersa might be revealed with advancing technical methods, such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry or 16S ribosomal RNA analysis. Physicians must know that a variety of infections caused by Pantoea dispersa could occur in immunocompromised as well as immunocompetent patients.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Bacteremia; Bile Ducts; Cholangitis; Enterobacteriaceae Infections; Female; Humans; Immunocompetence; Immunocompromised Host; Levofloxacin; Meropenem; Pantoea

The current management of acute cholangitis consists of antibiotic therapy in combination with biliary drainage. However, the optimal duration of antibiotic therapy after the resolution of clinical symptoms by biliary drainage is unclear. We aimed to evaluate whether discontinuing antibiotic therapy for acute cholangitis immediately after the resolution of clinical symptoms, achieved by endoscopic biliary drainage, was safe and effective.. This prospective study included patients with moderate and severe acute cholangitis. Cefmetazole sodium and meropenem hydrate were used as initial antibiotic therapy for patients with moderate and severe acute cholangitis, respectively. All patients underwent endoscopic biliary drainage within 24 h of diagnosis. When the body temperature of < 37 ° C was maintained for 24 h, administration of antibiotics was stopped. The primary endpoint was the recurrence of acute cholangitis within 3 days after the withdrawal of antibiotic therapy.. Eighteen patients were subjected to the final analysis. The causes of cholangitis were bile duct stone (n = 17) and bile duct cancer (n = 1). The severity of acute cholangitis was moderate in 14 patients and severe in 4. Body temperature of < 37 ° C was achieved in all patients after a median of 2 days (range 1-6) following endoscopic biliary drainage. Antibiotic therapy was administered for a median duration of 3 days (range 2-7). None of the patients developed recurrent cholangitis within 3 days after the withdrawal of antibiotics.. Fever-based antibiotic therapy for acute cholangitis is safe and effective when resolution of fever is achieved following endoscopic biliary drainage.

Topics: Acute Disease; Aged; Aged, 80 and over; Anti-Bacterial Agents; Cefmetazole; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis; Drainage; Female; Fever; Humans; Male; Meropenem; Middle Aged; Prospective Studies; Recurrence; Severity of Illness Index; Thienamycins; Treatment Outcome

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Cefepime; Ceftazidime; Cholangitis; Cholestasis; Drug Resistance, Bacterial; Escherichia coli; Humans; Imipenem; Meropenem; Retrospective Studies

In this case report we describe a boy with extrahepatic biliary atresia who underwent a Kasai hepatoportoenterostomy at six weeks of age. Beginning several weeks post-op, he had recurrent cholangitis inadequately controlled by various antibiotic prophylaxis regimens. Imaging revealed the development of several bile lakes in the liver hilum. Due to the recurrent nature of his cholangitis, and some evidence of acutely impaired biliary drainage, he underwent a refashioning of his portoenterostomy with resultant improved drainage. However, shortly thereafter, the patient developed ongoing fever and anemia. Culture of the bile lake aspirate grew multiresistant Klebsiella and a 6 week course of parenteral meropenume controlled his fever and his anemia improved. Following treatment cessation his fever and anemia returned. A biliary drain was inserted into his larger bile lake and following another course of parenteral antibiotics he has remained free of clinically detected cholangitis despite ongoing contamination of drained bile fluid. The development of bile lakes after Kasai hepatoportoenterostomy is not an uncommon finding. This have been associated with worse prognosis including increased incidence of cholangitis. Often, conservative treatment with prophylactic antibiotics suffices, however, in rare cases, more aggressive intervention may be considered including percutaneous bile drainage or surgical management. The benefit of these management strategies must be balanced with the potential gain regarding quality of life and delaying transplant, on an individual basis.

Topics: Anti-Bacterial Agents; Bile; Biliary Atresia; Cholangitis; Drug Resistance, Multiple, Bacterial; Humans; Infant; Klebsiella Infections; Male; Meropenem; Portoenterostomy, Hepatic; Postoperative Complications; Thienamycins