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Antibiotics May be Safely Discontinued Within One Week of Percutaneous Cholecystostomy

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Abstract

Background

For patients with acute cholecystitis managed with percutaneous cholecystostomy (PC), the optimal duration of post-procedural antibiotic therapy is unknown. Our objective was to compare short versus long courses of antibiotics with the hypothesis that patients with persistent signs of systemic inflammation 72 h following PC would receive prolonged antibiotic therapy and that antibiotic duration would not affect outcomes.

Methods

We performed a retrospective cohort analysis of 81 patients who underwent PC for acute cholecystitis at two hospitals during a 41-month period ending November 2014. Patients who received short (≤7 day) courses of post-procedural antibiotics were compared to patients who received long (>7 day) courses. Treatment response to PC was evaluated by systemic inflammatory response syndrome (SIRS) criteria. Logistic and linear regressions were used to evaluate associations between antibiotic duration and outcomes.

Results

Patients who received short (n = 30) and long courses (n = 51) of antibiotics had similar age, comorbidities, severity of cholecystitis, pre-procedural vital signs, treatment response, and culture results. There were no differences in recurrent cholecystitis (13 vs. 12%), requirement for open/converted to open cholecystectomy (23 vs. 22%), or 1-year mortality (20 vs. 18%). On logistic and linear regressions, antibiotic duration as a continuous variable was not predictive of any salient outcomes.

Conclusions

Patients who received short and long courses of post-PC antibiotics had similar baseline characteristics and outcomes. Antibiotic duration did not predict recurrent cholecystitis, interval open cholecystectomy, or mortality. These findings suggest that antibiotics may be safely discontinued within one week of uncomplicated PC.

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Acknowledgements

This manuscript has not been submitted or published elsewhere, and the authors have nothing to disclose. The authors acknowledge Drs. Loretta Coady-Fariborzian, MD and Elisha Collins, MD for their assistance in obtaining IRB approval. This work was supported in part by R01 GM113945-01 (PAE), R01 GM105893-01A1 (AMM), P50 GM111152–01 (SCB, FAM, PAE, AMM) awarded by the National Institute of General Medical Sciences (NIGMS). TJL was supported by a post-graduate training Grant (T32 GM-08721) in burns, trauma and perioperative injury by NIGMS. Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR001427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Surgery, University of Florida, 1600 SW Archer Road, PO Box 100108, Gainesville, FL, 32610, USA

    Tyler J. Loftus, Scott C. Brakenridge, Camille G. Dessaigne, George A. Sarosi Jr., William J. Zingarelli, Frederick A. Moore, Janeen R. Jordan, Chasen A. Croft, R. Stephen Smith, Phillip A. Efron & Alicia M. Mohr

  2. University of Florida Sepsis and Critical Illness Research Center, Gainesville, FL, USA

    Scott C. Brakenridge, Frederick A. Moore, Phillip A. Efron & Alicia M. Mohr

  3. Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, USA

    George A. Sarosi Jr. & William J. Zingarelli

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  1. Tyler J. Loftus
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  2. Scott C. Brakenridge
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  3. Camille G. Dessaigne
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Correspondence to Alicia M. Mohr.

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Loftus, T.J., Brakenridge, S.C., Dessaigne, C.G. et al. Antibiotics May be Safely Discontinued Within One Week of Percutaneous Cholecystostomy. World J Surg 41, 1239–1245 (2017). https://doi.org/10.1007/s00268-016-3861-y

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  • DOI: https://doi.org/10.1007/s00268-016-3861-y

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