Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain.
Department of General Surgery, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
Langenbecks Arch Surg. 2023 Aug 29;408(1):345. doi: 10.1007/s00423-023-03063-4.
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.
尽管严重急性胆石性胆囊炎（ACC）的死亡率和发病率仍然是一个令人关注的问题，但经验性抗生素治疗不足作为一个危险因素的影响尚未得到充分研究。本研究旨在评估经验性抗生素治疗的充分性对 ACC 并发症和死亡率的影响。
这是一项观察性回顾性队列图表为基础的单中心研究，于 2012 年至 2016 年进行。共纳入 963 例连续患者，选择单纯 ACC。收集一般、临床、术后和微生物学变量，并分析治疗不足的危险因素和后果。
76.3%的患者获得胆汁、血液和/或渗出液培养，老年、男性和重症患者更常获得培养（P<0.001）。接受培养的患者术后总并发症发生率（47.4%比 29.7%；P<0.001）和严重并发症发生率（11.6%比 4.7%；P=0.008）更高。阳性培养患者总并发症发生率（54.8%比 39.6%；P=0.001）、严重并发症发生率（16.3%比 6.7%；P=0.001）和死亡率（6%比 1.9%；P=0.012）更高。接受经验性抗生素治疗不足的患者死亡率是接受充分治疗患者的四倍（n=283；12.8%比 3.4%；P=0.003）。这种关联在严重 ACC TG-III 患者中更为明显（n=132；18.2%比 5.1%；P=0.018），并且在二元逻辑回归中仍然是死亡率的预测因素（OR 4.4；95%CI 1.3-15.3）。
阳性培养患者发生更多并发症，死亡率更高。经验性抗生素治疗的充分性在 ACC 中似乎至关重要，尤其是在重症患者中。
