Lahav Lauren, Goldberg Nitzan, Jiryis Tamara, Cristo Hadasa, Soback Hagai, Avital Shmuel, Rudnicki Yaron
Department of Surgery, Meir Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 6997801, Israel.
J Clin Med. 2025 Sep 18;14(18):6589. doi: 10.3390/jcm14186589.
Antibiotic discordance in patients undergoing percutaneous cholecystostomy (PCC) for acute cholecystitis (AC) remains a debated issue. While empiric therapy aims to cover the most common pathogens, source control via PCC may play a greater role in clinical outcomes. This study evaluates the impact of discordant antibiotic treatment on patient outcomes. This single-center retrospective cohort study analyzed 184 PCC procedures performed for AC between 2018 and 2020. Patient demographics, bile cultures, empirical antibiotic regimens, and clinical outcomes were analyzed, with a focus on the impact of discordant antibiotic coverage. Of the 184 PCC patients, 128 (69.5%) had positive bile cultures, with (34%), (24%), and (14%) being the most common pathogens. Resistant bacteria were identified in 28% of patients. Despite 42% ( = 78) receiving discordant antibiotics, there were no significant differences in mortality, complications, or length of hospital stay between the discordant and concordant groups. However, the 90-day readmission rate was significantly higher in the discordant group (64.1% vs. 47.2%, = 0.023). Although discordant antibiotic treatment did not impact short-term outcomes, it was associated with a significantly higher rate of readmission. These findings suggest that PCC may be the primary driver of acute management; however, inadequate antimicrobial coverage might influence long-term recurrence.
对于因急性胆囊炎（AC）接受经皮胆囊造瘘术（PCC）的患者，抗生素使用不一致仍是一个存在争议的问题。经验性治疗旨在覆盖最常见的病原体，而通过PCC进行源头控制可能在临床结局中发挥更大作用。本研究评估了抗生素治疗不一致对患者结局的影响。这项单中心回顾性队列研究分析了2018年至2020年间为AC进行的184例PCC手术。分析了患者的人口统计学特征、胆汁培养结果、经验性抗生素治疗方案和临床结局，重点关注抗生素覆盖不一致的影响。在184例PCC患者中，128例（69.5%）胆汁培养呈阳性，其中 （34%）、 （24%）和 （14%）是最常见的病原体。28%的患者鉴定出耐药菌。尽管42%（ = 78）的患者接受了不一致的抗生素治疗，但不一致组和一致组在死亡率、并发症或住院时间方面没有显著差异。然而，不一致组的90天再入院率显著更高（64.1%对47.2%， = 0.023）。虽然不一致的抗生素治疗并未影响短期结局，但它与显著更高的再入院率相关。这些发现表明，PCC可能是急性管理的主要驱动因素；然而，抗菌覆盖不足可能会影响长期复发。
