Antibiotic Resistance in Acute Cholecystitis Graded According to Tokyo Guidelines 2018: The First Prospective Study

Abstract

Introduction: Single-dose antibiotics are recommended for laparoscopic cholecystectomy, for symptomatic gall stones. However, very few studies are there for subgroup grade-2 and grade-3 cholecystitis according to Tokyo guidelines 2018. Material and methods: We retrospectively analysed outcomes of our protocol of no post-operative antibiotics in grade-2 and grade 3 (moderate to severe) acute cholecystitis according to Tokyo guidelines. We perform laparoscopic cholecystectomies within the first 24 hours of presentation to us without considering time since attack if the patient is not in septic shock where we follow survival sepsis guidelines and also perform percutaneous cholecystostomy. All the data were prospectively analysed. Statistical evaluation was done using SPSS version 21(IBM). Results: We performed 101 laparoscopic cholecystectomies between April 2016 to January 2019. We prefer single dose pre-operative antibiotic (third-generation cephalosporins) in all laparoscopic cholecystectomies and no post-operative antibiotics. A total of 74 patients were having grade 2 or grade 3 cholecystitis. 64 patients were having grade 2 and 9 patients were having grade 3 cholecystitis. One patient was having grade 3 cholecystitis and was having septic shock so he was managed with percutaneous cholecystostomy and according to survival sepsis protocol and lap choly was done after 72 hours and hence excluded from the study. Out of 73 patients included in the study, 2 patients were converted to open; in two patients we performed lap subtotal cholecystectomy due to a difficult calot triangle. Out of this only 1 patient developed port site infection and two patient developed biloma which was managed by percutaneous drainage. All patients were discharged the same day or the next day. Only two patients with biloma were readmitted. Rest all of the patients had an uneventful recovery. Conclusion: Post-operative antibiotics are unnecessary even in grade-2, grade-3 acute cholecystitis without septic shock according to Tokyo guidelines.