Loftus Tyler J, Brakenridge Scott C, Dessaigne Camille G, Sarosi George A, Zingarelli William J, Moore Frederick A, Jordan Janeen R, Croft Chasen A, Smith R Stephen, Efron Phillip A, Mohr Alicia M
Department of Surgery, University of Florida, 1600 SW Archer Road, PO Box 100108, Gainesville, FL, 32610, USA.
University of Florida Sepsis and Critical Illness Research Center, Gainesville, FL, USA.
World J Surg. 2017 May;41(5):1239-1245. doi: 10.1007/s00268-016-3861-y.
For patients with acute cholecystitis managed with percutaneous cholecystostomy (PC), the optimal duration of post-procedural antibiotic therapy is unknown. Our objective was to compare short versus long courses of antibiotics with the hypothesis that patients with persistent signs of systemic inflammation 72 h following PC would receive prolonged antibiotic therapy and that antibiotic duration would not affect outcomes.
We performed a retrospective cohort analysis of 81 patients who underwent PC for acute cholecystitis at two hospitals during a 41-month period ending November 2014. Patients who received short (≤7 day) courses of post-procedural antibiotics were compared to patients who received long (>7 day) courses. Treatment response to PC was evaluated by systemic inflammatory response syndrome (SIRS) criteria. Logistic and linear regressions were used to evaluate associations between antibiotic duration and outcomes.
Patients who received short (n = 30) and long courses (n = 51) of antibiotics had similar age, comorbidities, severity of cholecystitis, pre-procedural vital signs, treatment response, and culture results. There were no differences in recurrent cholecystitis (13 vs. 12%), requirement for open/converted to open cholecystectomy (23 vs. 22%), or 1-year mortality (20 vs. 18%). On logistic and linear regressions, antibiotic duration as a continuous variable was not predictive of any salient outcomes.
Patients who received short and long courses of post-PC antibiotics had similar baseline characteristics and outcomes. Antibiotic duration did not predict recurrent cholecystitis, interval open cholecystectomy, or mortality. These findings suggest that antibiotics may be safely discontinued within one week of uncomplicated PC.
对于采用经皮胆囊造瘘术（PC）治疗的急性胆囊炎患者，术后抗生素治疗的最佳疗程尚不清楚。我们的目的是比较短疗程与长疗程抗生素治疗，假设PC术后72小时仍有全身炎症持续体征的患者将接受延长的抗生素治疗，且抗生素疗程不会影响治疗结果。
我们对2014年11月结束的41个月期间在两家医院接受PC治疗急性胆囊炎的81例患者进行了回顾性队列分析。将接受短疗程（≤7天）术后抗生素治疗的患者与接受长疗程（>7天）治疗的患者进行比较。通过全身炎症反应综合征（SIRS）标准评估对PC的治疗反应。采用逻辑回归和线性回归评估抗生素疗程与治疗结果之间的关联。
接受短疗程（n = 30）和长疗程（n = 51）抗生素治疗的患者在年龄、合并症、胆囊炎严重程度、术前生命体征、治疗反应和培养结果方面相似。复发性胆囊炎（13%对12%）、开腹/转为开腹胆囊切除术的需求（23%对22%）或1年死亡率（20%对18%）方面无差异。在逻辑回归和线性回归中，抗生素疗程作为连续变量不能预测任何显著的治疗结果。
接受PC术后短疗程和长疗程抗生素治疗的患者具有相似的基线特征和治疗结果。抗生素疗程不能预测复发性胆囊炎、间隔期开腹胆囊切除术或死亡率。这些发现表明，在无并发症的PC术后一周内可安全停用抗生素。
