Inadequate empiric antibiotic treatment may significantly increase mortality among severe acute calculous cholecystitis patients

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.

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).

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

Reference:

Maite de Miguel-Palacio, Ana-María González-Castillo, Estela Membrilla-Fernández, María-José Pons-Fragero, Amalia Pelegrina-Manzano, Luis Grande-Posa, Ricard Morera-Casaponsa & Juan-José Sancho-Insenser. Impact of empiric antibiotic therapy on the clinical outcome of acute calculous cholecystitis

Research. Published: 29 August 2023, volume 408, Article number: 345 (2023).

Keywords:

Maite de Miguel-Palacio, Ana-María González-Castillo, Estela Membrilla-Fernández, María-José Pons-Fragero, Amalia Pelegrina-Manzano, Luis Grande-Posa, Ricard Morera-Casaponsa & Juan-José Sancho-Insenser, inadequate, empiric, antibiotic, treatment, may, significantly, increase, mortality, among, severe acute calculous, cholecystitis patients