Systematic review of antibiotic treatment for acute calculous cholecystitis

Dijk, Aafke H. van; Reuver, Philip R. de; Tasma, T.N.; Dieren, Susan van; Hugh, Tom; Boermeester, Marja A.

doi:10.1002/bjs.10146

Cited by 47 publications

(31 citation statements)

References 83 publications

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“…The use of preoperative prophylactic antibiotics is not suitable for low-risk patients undergoing LC. The main purpose of starting antibiotics in surgically managed cases of ACC is to prevent perioperative infectious complications[46], however, according to van Dijk et al[47] in recent systematic review, which assessed its effect in the course of ACC conclude: They are not effective for patients undergone to non-operative treatment neither in those one selected for cholecystectomy.…”

Section: Antimicrobial Treatmentmentioning

confidence: 99%

Acute calculous cholecystitis: Review of current best practices

Gomes¹,

Soares²,

Saverio³

et al. 2017

WJGS

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Acute calculous cholecystitis (ACC) is the most frequent complication of cholelithiasis and represents one-third of all surgical emergency hospital admissions, many aspects of the disease are still a matter of debate. Knowledge of the current evidence may allow the surgical team to develop practical bedside decision-making strategies, aiming at a less demanding procedure and lower frequency of complications. In this regard, recommendations on the diagnosis supported by specific criteria and severity scores are being implemented, to prioritize patients eligible for urgency surgery. Laparoscopic cholecystectomy is the best treatment for ACC and the procedure should ideally be performed within 72 h. Early surgery is associated with better results in comparison to delayed surgery. In addition, when to suspect associated common bile duct stones and how to treat them when found are still debated. The antimicrobial agents are indicated for high-risk patients and especially in the presence of gallbladder necrosis. The use of broad-spectrum antibiotics and in some cases with antifungal agents is related to better prognosis. Moreover, an emerging strategy of not converting to open, a difficult laparoscopic cholecystectomy and performing a subtotal cholecystectomy is recommended by adept surgical teams. Some authors support the use of percutaneous cholecystostomy as an alternative emergency treatment for acute Cholecystitis for patients with severe comorbidities.

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Section: Antimicrobial Treatmentmentioning

confidence: 99%

Acute calculous cholecystitis: Review of current best practices

Gomes¹,

Soares²,

Saverio³

et al. 2017

WJGS

View full text Add to dashboard Cite

show abstract

“…Similarly, the use of antibiotics is disputable even in the conservative management of acute cholecystitis. A recent systematic review 16 demonstrated that there is little evidence on this subject, and the available evidence is of poor quality and has a high risk of bias. The review identified only one small study 17 that compared antibiotic treatment with a conservative strategy without antibiotics, showing that antibiotics did not improve the outcome of acute calculous cholecystitis.…”

Section: Discussionmentioning

confidence: 99%

Randomized clinical trial of extended versus single-dose perioperative antibiotic prophylaxis for acute calculous cholecystitis

Loozen

Kortram

Kornmann

et al. 2017

British Journal of Surgery

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Background: Many patients who have surgery for acute cholecystitis receive postoperative antibiotic prophylaxis, with the intent to reduce infectious complications. There is, however, no evidence that extending antibiotics beyond a single perioperative dose is advantageous. This study aimed to determine the effect of extended antibiotic prophylaxis on infectious complications in patients with mild acute cholecystitis undergoing cholecystectomy.

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“…6 In contrast, a recent metaanalysis showed that antibiotics are not indicated in the conservative management of most patients with AC or in those scheduled for cholecystectomy, and should only be used in patients with moderate or severe AC. 18 In our study, most patients with histopathological AC (88%) were treated with antibiotics. However, 66% of patients with no histopathological evidence of AC were also treated with antibiotics raising the possibility that they may have been overtreated.…”

Section: Discussionmentioning

confidence: 62%

Acute cholecystitis or simple biliary colic after an emergency presentation: why it matters

Nguyen

Dijk

Smith

et al. 2019

ANZ Journal of Surgery

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Background Laparoscopic cholecystectomy (LC) is often performed during the index admission after emergency presentation for acute biliary pain. Many patients have acute cholecystitis (AC) that may increase operative difficulty and complications. Our primary aim was to assess the validity of Tokyo Guidelines (TG18) for diagnosing AC by comparison with the admitting team diagnosis, operative findings and histopathology. The secondary aim was to assess outcomes after same‐admission or delayed LC. Methods Retrospective analysis of patients who underwent LC after presenting to a tertiary hospital emergency department over a 12‐month period was conducted. Results A total of 139 patients underwent LC with no mortality or bile duct injury. A diagnosis of AC made by the admitting surgical team had sensitivity of 84% and specificity of 57%. The TG18 diagnosis had sensitivity of 84% and specificity of 53%. A diagnosis of AC by the admitting surgical team correlated well with TG18 criteria diagnosis. There was poor correlation between clinical and histopathological diagnoses. Nine percent of patients had complications and 4% required conversion to open procedure. Patients with a clinical diagnosis of AC had longer post‐operative length of stay and more complications compared with those who had non‐AC diagnosis. There was no difference in outcomes between same‐admission LC or delayed LC. Conclusion TG18 diagnosis of AC does not improve accuracy of diagnosis or predictability of a poor outcome over the admitting surgical team diagnosis. Same‐admission LC for patients with AC is associated with similar outcomes compared to those who undergo delayed LC.

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Systematic review of antibiotic treatment for acute calculous cholecystitis

Abstract: Antibiotics are not indicated for the conservative management of ACC or in patients scheduled for cholecystectomy.

Cited by 47 publications

References 83 publications

Acute calculous cholecystitis: Review of current best practices

Acute calculous cholecystitis: Review of current best practices

Randomized clinical trial of extended versus single-dose perioperative antibiotic prophylaxis for acute calculous cholecystitis

Acute cholecystitis or simple biliary colic after an emergency presentation: why it matters

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