Impact of Prior Endoscopic Sphincterotomy on Detection of Drug-Resistant Bacteria in Acute Cholecystitis

The Tokyo Guidelines 2018 recommend empirical antibiotic therapy for community-acquired acute cholecystitis based on disease severity. However, some studies suggest that other factors, such as prior endoscopic sphincterotomy (EST), may also influence antibiotic selection. This study aimed to investigate the impact of prior EST on the detection of multidrug-resistant bacteria (MDRB) in the bile cultures of patients with acute cholecystitis.

This single-center retrospective study included 238 patients with acute cholecystitis who underwent cholecystectomy or percutaneous gallbladder drainage between July 2018 and June 2023. The association between prior EST and MDRB detection was analyzed using modified Poisson regression adjusted for age, sex, diabetes, severity grade, and degree of inflammation.

Among the 238 patients, 162 (68.1%) had positive bile cultures and 40 (16.8%) had a history of EST. MDRB were detected in 39 patients (16.4%). Prior EST was significantly associated with MDRB detection (risk ratio [RR]: 2.89 and 95% confidence interval [CI]: 1.62-5.16), whereas severity grade showed no association (RR: 1.03 and 95% CI: 0.61-1.74). Among the MDRB subtypes, prior EST was not significantly associated with the detection of extended-spectrum beta-lactamase (ESBL)-producing bacteria (RR: 1.73 and 95% CI: 0.55-5.45); however, it was significantly associated with the detection of AmpC-producing bacteria (RR: 4.53 and 95% CI: 2.07-9.91). Prior EST was not associated with infectious complications (RR: 1.49 and 95% CI: 0.64-3.43) and 30-day mortality (RR: 1.04 and 95% CI: 0.12-8.98). Mean hospital stay was longer in the EST group than in the non-EST group (11 vs. 16 days).

Prior EST, rather than the severity grade of cholecystitis, may be a more relevant factor when selecting empirical antibiotic therapy for patients with acute cholecystitis.