DO WE USE ANTIBIOTICS CORRECTLY FOR THE TREATMENT OF ACUTE CHOLECYSTITIS?

Abstract

Abstract Introduction Adequate antibiotic therapy is one of the mainstays in treatment of acute cholecystitis. The Tokyo Guidelines 2018 (TG18) offer recommendations for the appropriate use of antimicrobials in clinical practice. This work evaluates whether antibiotic therapy in patients operated on for cholecystitis is in line with current recommendations. Methods Retrospective analysis of patients undergoing cholecystectomy for acute cholecystitis between 06/01/2021 and 12/31/2021. Demographic variables were collected, including risk factors (RRFF) for developing infectious complications or presenting multiresistant microorganisms, as well as SIRS criteria. Information was collected on antibiotic prophylaxis, empiric treatment, its duration, and adherence to both the guidelines and the results of the cultures. Finally, hospital stay and postoperative infectious complications were recorded. Results 64 patients were operated upon. 51.6% had RRFF of presenting infectious complications, 29.7% had SIRS criteria, 17.2% had RRFF of multiresistant bacteria. According to the TG18, 62.5% were grade 2. Antibiotic prophylaxis was administrated in 82.8% of the cases. Empirical treatment was maintained in 76.6% of the patients, with a mean duration of 5.87±4.1 days. The empirical antibiotic was adapted to the antibiogram in 57.9% of the cases. In none of the cases in which it was not adapted was the antibiotic changed. Surgical site infection was 7.8%. Conclusions The concordance of the empirical antibiotic treatment and its duration according to the guidelines, as well as the adequacy of the type of antibiotic according to the cultures, is only fulfilled in a little more than half of the cases.