Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis.

Published on Jan 1, 2018in Journal of Hepato-biliary-pancreatic Sciences4.16
· DOI :10.1002/JHBP.518
Harumi Gomi13
Estimated H-index: 13
(University of Tsukuba),
Joseph S. Solomkin69
Estimated H-index: 69
(University of Cincinnati Academic Health Center)
+ 56 AuthorsMasakazu Yamamoto63
Estimated H-index: 63
Antimicrobial therapy is a mainstay of the management for patients with acute cholangitis and/or cholecystitis. Tokyo Guidelines 2018 (TG 18) provides recommendations for the appropriate for 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 TG 18 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 TG 18 is that the duration of antimicrobial therapy for both acute cholangitis and cholecystitis is systematically reviewed. Prophylactic antimicrobial usage for elective endoscopic retrograde cholangiopancreatography (ERCP) is no more recommended and the section was deleted in TG 18. This article is protected by copyright. All rights reserved.
Figures & Tables
📖 Papers frequently viewed together
338 Citations
971 Citations
322 Citations
We propose a new flowchart for the treatment of acute cholecystitis (AC) in the Tokyo Guidelines 2018 (TG18). Grade III AC was not indicated for straightforward laparoscopic cholecystectomy (Lap-C). Following analysis of subsequent clinical investigations and drawing on Big Data in particular, TG18 proposes that some Grade III AC can be treated by Lap-C when performed at advanced centers with specialized surgeons experienced in this procedure and for patients that satisfy certain strict criteria...
212 CitationsSource
#1Masamichi YokoeH-Index: 27
#2Jiro Hata (Kawasaki Medical School)H-Index: 31
Last. Masakazu YamamotoH-Index: 63
view all 60 authors...
Although the diagnostic and severity grading criteria on the 2013 Tokyo Guidelines (TG13) are used worldwide as the primary standard for management of acute cholangitis (AC), they need to be validated through implementation and assessment in actual clinical practice. Here, we conduct a systematic review of the literature to validate the TG13 diagnostic and severity grading criteria for AC and propose TG18 criteria. While there is little evidence evaluating the TG13 criteria, they were validated ...
338 CitationsSource
#1Yasuhisa Mori (Kyushu University)H-Index: 20
#2Takao Itoi (TMU: Tokyo Medical University)H-Index: 76
Last. Masakazu YamamotoH-Index: 63
view all 60 authors...
Since the publication of the Tokyo Guidelines in 2007 and their revision in 2013, appropriate management for acute cholecystitis has been more clearly established. Since the last revision, several manuscripts, especially for alternative endoscopic techniques, have been reported; therefore, additional evaluation and refinement of the 2013 Guidelines is required. We describe a standard drainage method for surgically high-risk patients with acute cholecystitis and the latest developed endoscopic ga...
107 CitationsSource
#1Fumihiko Miura (Teikyo University)H-Index: 38
#2Kohji OkamotoH-Index: 41
Last. Masakazu YamamotoH-Index: 63
view all 58 authors...
The initial management of patients with suspected acute biliary infection starts with the measurement of vital signs to assess whether or not the situation is urgent. If the case is judged to be urgent, initial medical treatment should be started immediately including respiratory/circulatory management if required, without waiting for a definitive diagnosis. The patient's medical history is then taken; an abdominal examination is performed; blood tests, urinalysis, and diagnostic imaging are car...
111 CitationsSource
#1Shuntaro Mukai (TMU: Tokyo Medical University)H-Index: 23
#2Takao Itoi (TMU: Tokyo Medical University)H-Index: 76
Last. Masakazu YamamotoH-Index: 63
view all 24 authors...
: The Tokyo Guidelines 2013 (TG13) include new topics in the biliary drainage section. From these topics, we describe the indications and new techniques of biliary drainage for acute cholangitis with videos. Recently, many novel studies and case series have been published across the world, thus TG13 need to be updated regarding the indications and selection of biliary drainage based on published data. Herein, we describe the latest updated TG13 on biliary drainage in acute cholangitis with meta-...
56 CitationsSource
#1Harumi Gomi (University of Tsukuba)H-Index: 13
#2Tadahiro Takada (Teikyo University)H-Index: 68
Last. Masakazu YamamotoH-Index: 63
view all 19 authors...
Background The international practice guidelines for patients with acute cholangitis and cholecystitis were released in 2007 (TG 07) and revised in 2013 (TG 13).This study investigated updated epidemiology and outcomes among patients with acute cholangitis on a larger scale for the first time. Methods This is an international multi-center retrospective observational study in Japan and Taiwan. All consecutive patients older than 18 years of age and given a clinical diagnosis of acute cholangitis ...
29 CitationsSource
#1Jelle R. DalenbergH-Index: 9
#2Liselore WeitkampH-Index: 1
Last. Gert J. Ter HorstH-Index: 32
view all 5 authors...
The ventral emotion network -encompassing the amygdala, insula, ventral striatum, and ventral regions of the prefrontal cortex - has been associated with the identification of emotional significance of perceived external stimuli and the production of affective states. Functional magnetic resonance imaging (fMRI) studies investigating chemosensory stimuli have associated parts of this network with pleasantness coding. In the current study, we independently analyzed two datasets in which we measur...
13 CitationsSource
#1Shunsuke Uno (Keio: Keio University)H-Index: 7
#2Ryota HaseH-Index: 8
Last. Naoto HosokawaH-Index: 11
view all 7 authors...
Summary Objectives The optimal antimicrobial treatment duration for patients with acute cholangitis with bacteremia remains unknown. The updated Tokyo Guidelines 2013 recommend a minimum duration of 2 weeks only when bacteremia with Gram-positive cocci is present. Since May 2013, a shorter antimicrobial treatment duration of under 2 weeks has been implemented at the authors' institution for acute cholangitis with Gram-negative bacillary bacteremia. The aim of the present study was to validate th...
14 CitationsSource
#1Andrew Rhodes (St George's Hospital)H-Index: 70
#2Laura Evans (NYU: New York University)H-Index: 17
Last. R. Phillip Dellinger (Cooper University Hospital)H-Index: 37
view all 59 authors...
To provide an update to “Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012”. A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members i...
2,551 CitationsSource
#1John E. Mazuski (WashU: Washington University in St. Louis)H-Index: 40
#2Jeffrey M. TessierH-Index: 7
Last. Jose M. Prince (Hofstra University)H-Index: 10
view all 12 authors...
Abstract Background: Previous evidence-based guidelines on the management of intra-abdominal infection (IAI) were published by the Surgical Infection Society (SIS) in 1992, 2002, and 2010. At the time the most recent guideline was released, the plan was to update the guideline every five years to ensure the timeliness and appropriateness of the recommendations. Methods: Based on the previous guidelines, the task force outlined a number of topics related to the treatment of patients with IAI and ...
191 CitationsSource
Cited By110
The intrahepatic biliary tract is essential for physiologic homeostasis. Disease that results in aberrant function can have serious deleterious consequences and result in considerable morbidity and mortality. This review aimed to summarise clinically relevant updates on intrahepatic biliary disorders in dogs including human corollaries.
#1Neev Tchernin (Hillel Yaffe Medical Center)
#2Maya Paran (Hillel Yaffe Medical Center)
Last. D. Aranovich (Hillel Yaffe Medical Center)
view all 6 authors...
Background: Calculus biliary disease is a common condition that requires invasive procedures in complicated cases. The effect of biliary instrumentation on the biliary microbiome and its impact on ...
#1Thomas Zheng Jie Teng (NTU: Nanyang Technological University)H-Index: 1
#2Vishal G. Shelat (NTU: Nanyang Technological University)H-Index: 21
#1Wong Hoi She (HKU: University of Hong Kong)H-Index: 12
#2Wing Chiu Dai (HKU: University of Hong Kong)H-Index: 15
Last. Chung Mau Lo (HKU: University of Hong Kong)H-Index: 109
view all 6 authors...
The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original J...
#1A. SokalH-Index: 1
#2Sylvain ChawkiH-Index: 2
Last. Victoire de Lastours (University of Paris)H-Index: 13
view all 8 authors...
Pancreatic and biliary duct cancers are increasing causes of acute cholangitis (AC). We retrospectively characterize 81 cancer-associated cholangitis (CAC) compared to 49 non-cancer-associated cholangitis (NCAC). Clinical and biological presentations were similar. However, in CAC, antibiotic resistance and inadequate empirical antibiotic therapy were more frequent; more patients required ≥ 2 biliary drainages; and mortality at day 28 was higher than in NCAC. Death was associated with initial sev...
#2Wei-Ting Chen (Memorial Hospital of South Bend)H-Index: 15
view all 8 authors...
Background and Aim Biliary tract infection (BTI) is an inflammatory disease and commonly associated with bacteremia. Delays in diagnosis or treatment of BTI cause high morbidity and mortality. However, an early diagnosis depends on appropriate clinical investigations. Appropriate biomarkers are urgently needed to improve the BTI diagnostic rate. We hypothesized that intestinal fatty acid-binding protein (I-FABP) might be a potential biomarker for BTI diagnosis. Methods We examined data from subj...
#1Pouya Entezari (NU: Northwestern University)H-Index: 1
#2Jonathan A. Aguiar (NU: Northwestern University)
Last. Ahsun Riaz (NU: Northwestern University)H-Index: 8
view all 4 authors...
Acute cholangitis presents with a wide severity spectrum and can rapidly deteriorate from local infection to multiorgan failure and fatal sepsis. The pathophysiology, diagnosis, and general management principles will be discussed in this review article. The focus of this article will be on the role of biliary drainage performed by interventional radiology to manage acute cholangitis. There are specific scenarios where percutaneous drainage should be preferred over endoscopic drainage. Percutaneo...
#1Kumble Seetharama Madhusudhan (AIIMS: All India Institute of Medical Sciences)H-Index: 14
#2Valakkada Jineesh (Sree Chitra Thirunal Institute for Medical Sciences and Technology)
Last. Shyamkumar N. Keshava (Christian Medical College & Hospital)H-Index: 14
view all 3 authors...
Percutaneous biliary interventions are among the commonly performed nonvascular radiological interventions. Most common of these interventions is the percutaneous transhepatic biliary drainage for malignant biliary obstruction. Other biliary procedures performed include percutaneous cholecystostomy, biliary stenting, drainage for bile leaks, and various procedures like balloon dilatation, stenting, and large-bore catheter drainage for bilioenteric or post-transplant anastomotic strictures. Altho...