Susceptibility of Bile Cultures to Empiric Antibiotic Therapy and Impact on Clinical Outcomes in Patients with Acute Cholecystitis Undergoing Percutaneous Cholecystostomy Perkütan Kolesistostomi Uygulanan Akut Kolesistitli Hastalarda Safra Kültürlerinin Ampirik Antibiyotik Tedavisine Duyarlılığı ve Klinik Sonuçlar Üzerindeki Etkisi

Creative Commons License

Namdaroğlu O. B., Dikişer F., Öztürk S., KAMER K. E., YAKAN S.

Anatolian Journal of General Medical Research, cilt.35, sa.3, ss.339-344, 2025 (Scopus, TRDizin)

Özet

Objective: To characterize biliary microbiology, quantify empiric antibiotic-culture susceptibility concordance, and identify mortality-associated factors among acute cholecystitis (AC) patients undergoing percutaneous cholecystostomy (PC). Methods: We conducted a retrospective single-center cohort (January 2019-June 2024) of adults with AC treated by PC (n=86). Diagnosis relied on clinical, laboratory, and imaging criteria; severity was graded per Tokyo Guidelines 2018 (grade II-III). Collected variables included demographics, comorbidities [Charlson comorbidity index (CCI), C-reactive protein (CRP)/procalcitonin (PCT)], empiric regimen, bile culture/susceptibility, and clinical outcomes. Concordance was defined as full coverage of all cultured organisms by the initial empiric regimen. Multivariable logistic regression assessed predictors of mortality. Results: Mean age was 72.1±14.0 years; 48.8% were female. Tokyo grade II 85%, grade III 15%; CCI: 1.10±1.08. The predominant empiric regimen was 3rd-generation cephalosporin plus metronidazole (89.5%). Overall bile culture positivity was 68.6%; leading organisms were Escherichia coli (35%), Enterococcus spp. (22%), and Klebsiella spp. (18%). Empiric-culture concordance was 57.1%, with the most prominent discordance for Enterococcus (coverage 31.0%). Length of stay, drain removal time, and CCI did not differ between concordant versus discordant therapy. Overall mortality was 10.5%. In multivariable analysis, age independently predicted mortality [odds ratio (OR)=1.12, p=0.03]; higher Tokyo grade showed a non-significant upward trend (p=0.16). Concordance showed a protective trend for mortality (OR=0.23, p=0.12). Conclusion: In AC managed with PC and timely source-control, empiric-culture concordance is moderate and appears to have limited impact on short-term mortality, which is primarily driven by age and disease severity. The frequency of Enterococcus underlies most discordance and should inform empiric choices. These findings support rapid de-escalation and short-course, targeted antibiotics following adequate drainage.