Impact of empiric antibiotic therapy on the clinical outcome of acute calculous cholecystitis
de Miguel-Palacio, Maite (Institut Hospital del Mar d'Investigacions Mèdiques)
González-Castillo, Ana María (Universitat Pompeu Fabra. Departament de Medicina i Ciències de la Vida)
Membrilla Fernández, Estela (Universitat Pompeu Fabra. Departament de Medicina i Ciències de la Vida)
Pons-Fragero, María-José (Institut Hospital del Mar d'Investigacions Mèdiques)
Pelegrina-Manzano, Amalia (Universitat Pompeu Fabra. Departament de Medicina i Ciències de la Vida)
Grande, L (Institut Hospital del Mar d'Investigacions Mèdiques)
Morera-Casaponsa, Ricard (Universitat Pompeu Fabra. Departament de Medicina i Ciències de la Vida)
Sancho Insenser, Joan Josep (Institut Hospital del Mar d'Investigacions Mèdiques)
Universitat Autònoma de Barcelona

Date:	2023
Abstract:	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. 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. 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). 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. The online version contains supplementary material available at 10. 1007/s00423-023-03063-4.
Grants:	Universitat Autònoma de Barcelona
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Cholecystitis ; Acute calculous cholecystitis ; High-risk patients ; Empiric antibiotic treatment ; Tokyo Guidelines ; Antibiotic adequacy
Published in:	Langenbeck's archives of surgery, Vol. 408 (august 2023) , ISSN 1435-2451

DOI: 10.1007/s00423-023-03063-4
PMID: 37644336

9 p, 910.4 KB

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