Microbial profile, antibiotic sensitivity pattern and empirical antibiotic therapy in acute cholecystitis. A Retrospective observational study

Abstract

Background In moderate or severe acute cholecystitis, effective antibiotic therapy is important. We aimed to analyze microorganisms isolated from the bile of patients treated with percutaneous transhepatic gallbladder drainage and their antibiotic susceptibility patterns to assess empirical antibiotic therapy in patients with acute cholecystitis. Methods A retrospective descriptive study of clinical data from patients with acute cholecystitis treated with PTGBD at Zhejiang Provincial People's Hospital from January 2020 to December 2022. Results Totally, 127 patients' clinical data were collected. 82 patients yielded positive for bile culture and 16 patients yielded positive for blood bacterial culture for at least 1 organism. A total of 124 microorganisms were isolated 19 bacterial and 1 fungal species. Escherichia coli (31.7%), Klebsiella pneumoniae (24.4%), Enterococcus faecium (8.9%), and Enterococcus faecalis(5.6%) were the most frequently isolated pathogenic organisms. Drug sensitivity studies have shown that Gram-negative bacteria are less susceptible to quinolones and cephalosporins, while Gram-positive bacteria are more resistant to erythromycin, and Streptomycin. Long-term nursing home stays are a risk factor for the generation of drug-resistant bacteria. Conclusions Escherichia coli, Klebsiella pneumoniae, and enterococcus are common causative agents of acute cholecystitis and they are highly resistant to clinically used antibiotics such as quinolones, cephalosporins, erythromycin, and Streptomycin. Empirical antibiotic use should cover both gram-negative and gram-positive bacteria, with triple-cephalosporins in combination with beta-lactamase inhibitors, carbapenem antibiotics such as imipenem and ertapenem preferred, and may be downgraded when the source of infection is controlled. Nursing facility patients should be aware of multi-drug-resistant bacteria.