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Observational Study
. 2023 Aug 29;408(1):345.
doi: 10.1007/s00423-023-03063-4.

Impact of empiric antibiotic therapy on the clinical outcome of acute calculous cholecystitis

Maite de Miguel-Palacio  1   2 , Ana-María González-Castillo  3   4 , Estela Membrilla-Fernández  3   4 , María-José Pons-Fragero  3 , Amalia Pelegrina-Manzano  3   4 , Luis Grande-Posa  5   3 , Ricard Morera-Casaponsa  4 , Juan-José Sancho-Insenser  5   3
Affiliations
Observational Study

Impact of empiric antibiotic therapy on the clinical outcome of acute calculous cholecystitis

Maite de Miguel-Palacio et al. Langenbecks Arch Surg. .

Abstract

Purpose: Although mortality and morbidity of severe acute calculous cholecystitis (ACC) are still a matter of concern, the impact of inadequate empirical antibiotic therapy has been poorly studied as a risk factor. The objective was to assess the impact of the adequacy of empirical antibiotic therapy on complication and mortality rates in ACC.

Methods: This observational retrospective cohort chart-based single-center study was conducted between 2012 and 2016. A total of 963 consecutive patients were included, and pure ACC was selected. General, clinical, postoperative, and microbiological variables were collected, and risk factors and consequences of inadequate treatment were analyzed.

Results: Bile, blood, and/or exudate cultures were obtained in 76.3% of patients, more often in old, male, and severely ill patients (P < 0.001). Patients who were cultured had a higher overall rate of postoperative complications (47.4% vs. 29.7%; P < 0.001), as well as of severe complications (11.6% vs. 4.7%; P = 0.008). Patients with positive cultures had more overall complications (54.8% vs. 39.6%; P = 0.001), more severe complications (16.3% vs. 6.7%; P = 0.001), and higher mortality rates (6% vs. 1.9%; P = 0.012). Patients who received inadequate empirical antibiotic therapy had a fourfold higher mortality rate than those receiving adequate therapy (n = 283; 12.8% vs. 3.4%; P = 0.003). This association was especially marked in severe ACC TG-III patients (n = 132; 18.2 vs. 5.1%; P = 0.018) and remained a predictor of mortality in a binary logistic regression (OR 4.4; 95% CI 1.3-15.3).

Conclusion: Patients with positive cultures developed more complications and faced higher mortality. Adequate empirical antibiotic therapy appears to be of paramount importance in ACC, particularly in severely ill patients.

Keywords: Acute calculous cholecystitis; Antibiotic adequacy; Cholecystitis; Empiric antibiotic treatment; High-risk patients; Tokyo Guidelines.

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Conflict of interest statement

The authors declare no competing interests.

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Patient selection and patient flow diagram
See this image and copyright information in PMC

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