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

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• dc.contributor.author Miguel Palacio, Maite de
• dc.contributor.author González Castillo, Ana María
• dc.contributor.author Membrilla Fernández, Estela
• dc.contributor.author Pons Fragero, María José
• dc.contributor.author Pelegrina Manzano, Amalia
• dc.contributor.author Grande Posa, Luís
• dc.contributor.author Morera Casaponsa, Josep Ricard
• dc.contributor.author Sancho Insenser, Juan
• dc.date.accessioned 2024-05-27T06:20:52Z
• dc.date.available 2024-05-27T06:20:52Z
• dc.date.issued 2023
• dc.description.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.
• dc.format.mimetype application/pdf
• dc.identifier.citation de Miguel-Palacio M, González-Castillo AM, Membrilla-Fernández E, Pons-Fragero MJ, Pelegrina-Manzano A, Grande-Posa L, et al. Impact of empiric antibiotic therapy on the clinical outcome of acute calculous cholecystitis. Langenbecks Arch Surg. 2023 Aug 29;408(1):345. DOI: 10.1007/s00423-023-03063-4
• dc.identifier.doi http://dx.doi.org/10.1007/s00423-023-03063-4
• dc.identifier.issn 1435-2443
• dc.identifier.uri http://hdl.handle.net/10230/60247
• dc.language.iso eng
• dc.publisher Springer
• dc.relation.ispartof Langenbecks Arch Surg. 2023 Aug 29;408(1):345
• dc.rights © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Acute calculous cholecystitis
• dc.subject.keyword Antibiotic adequacy
• dc.subject.keyword Cholecystitis
• dc.subject.keyword Empiric antibiotic treatment
• dc.subject.keyword High-risk patients
• dc.subject.keyword Tokyo Guidelines
• dc.title Impact of empiric antibiotic therapy on the clinical outcome of acute calculous cholecystitis
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion