HPB P33 Evaluating the Disease Burden of Gram-negative Bacteraemia Secondary to Cholelithiasis in a Multi-site District General Hospital

Abstract

Abstract Background The incidence of symptomatic cholelithiasis continues to rise. We are now observing an increasing number of cases within an elderly, frail, co-morbid patient population. Gram-negative bacteraemia (GNB) secondary to cholelithiasis in this high-risk patient cohort carries a significant morbidity and mortality rate. Reducing GNB rates has been identified as a national target by Public Health England. Our aim is to evaluate the burden of GNB due to cholelithiasis and the management received in a district general hospital in order to inform approaches to reducing the burden of GNB. Methods A cross-site audit was conducted across two ‘hot’ district general hospitals serving approximately 1 million people within the same NHS foundation trust. Patients with positive blood cultures for GNB secondary to cholelithiasis were identified. Data was collected regarding patient demographics, survival outcomes, whether definitive treatment for cholelithiasis was performed on the index admission and re-admission rates. Results A total of 176 GNB patients from a microbiology database were analysed of which 69 (39%) were identified to have gallstone disease on index admission. Median age of the cohort was 81 years old. Only 10 patients (14%) received a cholecystectomy. Previous gallstone-related admission was found in 23 patients, therefore 23/176 (13%) of GNBs were potentially preventable. Assessment of fitness found 11/176 (6%) were preventable as they were fit for surgery at index non-GNB biliary admission, 4 patients were on a waiting list. Overall, 25 patients were unfit for surgery of which 12 received a drain and 6 were readmitted. Conclusions This audit demonstrated a significant proportion of GNB is caused by gallstone disease however a minority of patients are receiving surgery during admission, relinquishing the opportunity to prevent readmission in surgically fit patients. With long waiting times for elective procedures, combatting the burden of GNB requires a shift towards the use of acute cholecystectomy lists. With an increasingly frail population optimal non-operative management is essential to reducing GNB burden, almost half of these patients received a drain which evidence suggests does not reduce recurrence. Greater use of cystic duct stents advised by NICE in this cohort may reduce GNB admissions.