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Impact of Remote Cholecystectomy on Clinical Outcomes Following Pseudomonas aeruginosa Bloodstream Infection
Hanna K Bertucci1, Lyndsey R Heise1,2, Anne Kurze1
1Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Background:
Mortality associated with Pseudomonas aeruginosa bloodstream infection (PABSI) remains high despite advances in clinical care and therapeutics. In a recent study using a mouse model of PABSI, the gallbladder was identified as a reservoir for bacterial expansion. Furthermore, bile exposure has been linked to increased antimicrobial resistance. Therefore, we asked whether patients with retained gallbladders might experience more antimicrobial-resistant PABSIs, extended culture positivity, and worsened clinical outcomes.
Methods:
We conducted a retrospective cohort study of adults hospitalized over a 5-year period with PABSI. PABSI cases were defined as patients with ≥1 positive P. aeruginosa bacterial culture from the blood. Patients were categorized as those retaining a gallbladder (no cholecystectomy) or not (cholecystectomy). Cholecystectomy was defined as a history of cholecystectomy ≥1 year prior to the index episode of PABSI. Inferential statistics were used to identify associations between remote cholecystectomy and antimicrobial resistance profile, length of blood culture positivity, and in-hospital and 90-day mortality.
Results:
The overall study population included 336 patients: 262 (78%) with a retained gallbladder and 74 (22%) without. Using the entire study population and a matched cohort, we observed no difference in length of culture positivity, 90-day mortality, or in-hospital mortality between groups based on the presence of a gallbladder. Overall, composite 90-day mortality was 30.1%, which was similar to a prior investigation of PABSI outcomes at our institution. While the presence of a gallbladder did not affect the outcome, patients with PABSI and liver disease had significantly higher 90-day mortality than those without liver disease. Furthermore, no robust differences were observed in the antimicrobial resistance profile of P. aeruginosa isolates from the group with or without a gallbladder.
Conclusions:
In our study, neither PABSI antimicrobial resistance pattern nor clinical outcomes were affected by remote cholecystectomy. However, we do demonstrate that mortality for patients with PABSI in the modern era remains high despite advances in antipseudomonal therapeutics.
Insights
Retained gallbladders did not impact outcomes for Pseudomonas aeruginosa bloodstream infections (PABSI). Mortality for PABSI remains high, but gallbladder presence did not affect resistance or patient survival.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Surgical Outcomes
Background:
- Pseudomonas aeruginosa bloodstream infection (PABSI) has high mortality.
- The gallbladder may serve as a reservoir for P. aeruginosa expansion.
- Bile exposure is linked to increased antimicrobial resistance.
Purpose of the Study:
- To investigate if patients with retained gallbladders have more antimicrobial-resistant PABSIs.
- To determine if gallbladder presence affects culture positivity duration and clinical outcomes.
- To assess the impact of cholecystectomy on PABSI severity.
Main Methods:
- Retrospective cohort study of adult PABSI patients over 5 years.
- Categorization into retained gallbladder and cholecystectomy groups (≥1 year prior).
- Analysis of antimicrobial resistance, culture positivity, and mortality (in-hospital and 90-day).
Main Results:
- No significant difference in culture positivity, in-hospital, or 90-day mortality between groups.
- Overall 90-day mortality was 30.1%.
- Liver disease was associated with significantly higher 90-day mortality in PABSI patients.
Conclusions:
- Remote cholecystectomy did not affect PABSI antimicrobial resistance patterns or clinical outcomes.
- Mortality for PABSI remains high, underscoring the need for improved management strategies.
- Gallbladder presence was not a determinant of PABSI outcomes in this cohort.
