Impact of empiric antibiotic therapy on the clinical outcome of acute calculous cholecystitis
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...
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| Veröffentlicht in: | Langenbeck's archives of surgery 2023-08, Vol.408 (1), p.345-345, Article 345 |
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| creator | de Miguel-Palacio, Maite González-Castillo, Ana-María Membrilla-Fernández, Estela Pons-Fragero, María-José Pelegrina-Manzano, Amalia Grande-Posa, Luis Morera-Casaponsa, Ricard Sancho-Insenser, Juan-José |
| description | 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
|
| doi_str_mv | 10.1007/s00423-023-03063-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10465626</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2858986503</sourcerecordid><originalsourceid>FETCH-LOGICAL-c447t-b1532d3fe6e796b7820df8591c18e4ea9d06a148cd5016fe34b7a72519c8d8173</originalsourceid><addsrcrecordid>eNp9Uctu1TAQtRCIlsIPsEBZsgmM42dWqKp4VKrEBpbIcpxJrysnDrZT6f49jm6pyobFyEc6j7F9CHlL4QMFUB8zAO9YC_swkKzlz8g55Uy0HRf0-RN8Rl7lfAcAUvX8JTljSnLOmDwnv67n1brSxKnBefXJu8YuxQ8-lgrLAZNdj01cdti44BfvbGjiVlyccXdZt5XK2OC2ELfcuEMM6I65-OLza_JisiHjm4fzgvz88vnH1bf25vvX66vLm9Zxrko7UMG6kU0oUfVyULqDcdKip45q5Gj7EaSlXLtRAJUTMj4oqzpBe6dHTRW7IJ9Oues2zDg6XEqywazJzzYdTbTe_Mss_mBu472hwKWQnawJ7x8SUvy9YS5m9tlhCHbB-izTaaF7LQWwKu1OUpdizgmnxz0UzF6MORVjYJ-9GMOr6d3TGz5a_jZRBewkyJVabjGZu7ilpf7a_2L_ALvomu0</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2858986503</pqid></control><display><type>article</type><title>Impact of empiric antibiotic therapy on the clinical outcome of acute calculous cholecystitis</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>de Miguel-Palacio, Maite ; González-Castillo, Ana-María ; Membrilla-Fernández, Estela ; Pons-Fragero, María-José ; Pelegrina-Manzano, Amalia ; Grande-Posa, Luis ; Morera-Casaponsa, Ricard ; Sancho-Insenser, Juan-José</creator><creatorcontrib>de Miguel-Palacio, Maite ; González-Castillo, Ana-María ; Membrilla-Fernández, Estela ; Pons-Fragero, María-José ; Pelegrina-Manzano, Amalia ; Grande-Posa, Luis ; Morera-Casaponsa, Ricard ; Sancho-Insenser, Juan-José</creatorcontrib><description>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.</description><identifier>ISSN: 1435-2451</identifier><identifier>ISSN: 1435-2443</identifier><identifier>EISSN: 1435-2451</identifier><identifier>DOI: 10.1007/s00423-023-03063-4</identifier><identifier>PMID: 37644336</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Abdominal Surgery ; Cardiac Surgery ; Cholecystitis, Acute - drug therapy ; Cholecystitis, Acute - surgery ; General Surgery ; Humans ; Male ; Medicine ; Medicine & Public Health ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Risk Factors ; Thoracic Surgery ; Traumatic Surgery ; Vascular Surgery</subject><ispartof>Langenbeck's archives of surgery, 2023-08, Vol.408 (1), p.345-345, Article 345</ispartof><rights>The Author(s) 2023</rights><rights>2023. The Author(s).</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c447t-b1532d3fe6e796b7820df8591c18e4ea9d06a148cd5016fe34b7a72519c8d8173</citedby><cites>FETCH-LOGICAL-c447t-b1532d3fe6e796b7820df8591c18e4ea9d06a148cd5016fe34b7a72519c8d8173</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00423-023-03063-4$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00423-023-03063-4$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37644336$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>de Miguel-Palacio, Maite</creatorcontrib><creatorcontrib>González-Castillo, Ana-María</creatorcontrib><creatorcontrib>Membrilla-Fernández, Estela</creatorcontrib><creatorcontrib>Pons-Fragero, María-José</creatorcontrib><creatorcontrib>Pelegrina-Manzano, Amalia</creatorcontrib><creatorcontrib>Grande-Posa, Luis</creatorcontrib><creatorcontrib>Morera-Casaponsa, Ricard</creatorcontrib><creatorcontrib>Sancho-Insenser, Juan-José</creatorcontrib><title>Impact of empiric antibiotic therapy on the clinical outcome of acute calculous cholecystitis</title><title>Langenbeck's archives of surgery</title><addtitle>Langenbecks Arch Surg</addtitle><addtitle>Langenbecks Arch Surg</addtitle><description>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.</description><subject>Abdominal Surgery</subject><subject>Cardiac Surgery</subject><subject>Cholecystitis, Acute - drug therapy</subject><subject>Cholecystitis, Acute - surgery</subject><subject>General Surgery</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Postoperative Complications</subject><subject>Postoperative Period</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Thoracic Surgery</subject><subject>Traumatic Surgery</subject><subject>Vascular Surgery</subject><issn>1435-2451</issn><issn>1435-2443</issn><issn>1435-2451</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><recordid>eNp9Uctu1TAQtRCIlsIPsEBZsgmM42dWqKp4VKrEBpbIcpxJrysnDrZT6f49jm6pyobFyEc6j7F9CHlL4QMFUB8zAO9YC_swkKzlz8g55Uy0HRf0-RN8Rl7lfAcAUvX8JTljSnLOmDwnv67n1brSxKnBefXJu8YuxQ8-lgrLAZNdj01cdti44BfvbGjiVlyccXdZt5XK2OC2ELfcuEMM6I65-OLza_JisiHjm4fzgvz88vnH1bf25vvX66vLm9Zxrko7UMG6kU0oUfVyULqDcdKip45q5Gj7EaSlXLtRAJUTMj4oqzpBe6dHTRW7IJ9Oues2zDg6XEqywazJzzYdTbTe_Mss_mBu472hwKWQnawJ7x8SUvy9YS5m9tlhCHbB-izTaaF7LQWwKu1OUpdizgmnxz0UzF6MORVjYJ-9GMOr6d3TGz5a_jZRBewkyJVabjGZu7ilpf7a_2L_ALvomu0</recordid><startdate>20230829</startdate><enddate>20230829</enddate><creator>de Miguel-Palacio, Maite</creator><creator>González-Castillo, Ana-María</creator><creator>Membrilla-Fernández, Estela</creator><creator>Pons-Fragero, María-José</creator><creator>Pelegrina-Manzano, Amalia</creator><creator>Grande-Posa, Luis</creator><creator>Morera-Casaponsa, Ricard</creator><creator>Sancho-Insenser, Juan-José</creator><general>Springer Berlin Heidelberg</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20230829</creationdate><title>Impact of empiric antibiotic therapy on the clinical outcome of acute calculous cholecystitis</title><author>de Miguel-Palacio, Maite ; González-Castillo, Ana-María ; Membrilla-Fernández, Estela ; Pons-Fragero, María-José ; Pelegrina-Manzano, Amalia ; Grande-Posa, Luis ; Morera-Casaponsa, Ricard ; Sancho-Insenser, Juan-José</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c447t-b1532d3fe6e796b7820df8591c18e4ea9d06a148cd5016fe34b7a72519c8d8173</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Abdominal Surgery</topic><topic>Cardiac Surgery</topic><topic>Cholecystitis, Acute - drug therapy</topic><topic>Cholecystitis, Acute - surgery</topic><topic>General Surgery</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Postoperative Complications</topic><topic>Postoperative Period</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Thoracic Surgery</topic><topic>Traumatic Surgery</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>de Miguel-Palacio, Maite</creatorcontrib><creatorcontrib>González-Castillo, Ana-María</creatorcontrib><creatorcontrib>Membrilla-Fernández, Estela</creatorcontrib><creatorcontrib>Pons-Fragero, María-José</creatorcontrib><creatorcontrib>Pelegrina-Manzano, Amalia</creatorcontrib><creatorcontrib>Grande-Posa, Luis</creatorcontrib><creatorcontrib>Morera-Casaponsa, Ricard</creatorcontrib><creatorcontrib>Sancho-Insenser, Juan-José</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Langenbeck's archives of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>de Miguel-Palacio, Maite</au><au>González-Castillo, Ana-María</au><au>Membrilla-Fernández, Estela</au><au>Pons-Fragero, María-José</au><au>Pelegrina-Manzano, Amalia</au><au>Grande-Posa, Luis</au><au>Morera-Casaponsa, Ricard</au><au>Sancho-Insenser, Juan-José</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of empiric antibiotic therapy on the clinical outcome of acute calculous cholecystitis</atitle><jtitle>Langenbeck's archives of surgery</jtitle><stitle>Langenbecks Arch Surg</stitle><addtitle>Langenbecks Arch Surg</addtitle><date>2023-08-29</date><risdate>2023</risdate><volume>408</volume><issue>1</issue><spage>345</spage><epage>345</epage><pages>345-345</pages><artnum>345</artnum><issn>1435-2451</issn><issn>1435-2443</issn><eissn>1435-2451</eissn><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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>37644336</pmid><doi>10.1007/s00423-023-03063-4</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1435-2451 |
| ispartof | Langenbeck's archives of surgery, 2023-08, Vol.408 (1), p.345-345, Article 345 |
| issn | 1435-2451 1435-2443 1435-2451 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10465626 |
| source | MEDLINE; SpringerNature Journals |
| subjects | Abdominal Surgery Cardiac Surgery Cholecystitis, Acute - drug therapy Cholecystitis, Acute - surgery General Surgery Humans Male Medicine Medicine & Public Health Postoperative Complications Postoperative Period Retrospective Studies Risk Factors Thoracic Surgery Traumatic Surgery Vascular Surgery |
| title | Impact of empiric antibiotic therapy on the clinical outcome of acute calculous cholecystitis |
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