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From Guidelines to Practice: Closing the Antibiotic Stewardship Gap in Acute Cholecystitis
Sophia M McKenzie1, Danielle M Isaacson1, Mason H Remondelli2,3
1School of Medicine, The Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
The American Surgeon
|July 28, 2026
Summary
Adherence to Infectious Diseases Society of America (IDSA) guidelines for treating mild-to-moderate acute cholecystitis was suboptimal. Improving antibiotic stewardship requires standardized protocols and provider education.
Area of Science:
- Infectious Diseases
- Surgical Quality Improvement
- Antibiotic Stewardship
Background:
- Acute cholecystitis impacts ~200,000 individuals annually in the US, potentially causing significant morbidity.
- The Infectious Diseases Society of America (IDSA) provides guidelines for first-line antibiotic therapy in biliary infections.
- Variable adherence to IDSA guidelines for acute cholecystitis treatment was noted.
Purpose of the Study:
- To evaluate adherence to IDSA guideline-recommended antibiotic therapy for mild-to-moderate acute cholecystitis.
- To identify opportunities for quality optimization in antibiotic stewardship for acute biliary disease.
Main Methods:
- Retrospective review of the Emergency General Surgery (EGS) Registry at a military treatment facility.
- Inclusion of adult patients diagnosed with mild-to-moderate acute cholecystitis between 2017 and 2021.
- Analysis of antibiotic administration compared to IDSA recommendations.
Main Results:
- 143 patients met inclusion criteria; 62% were female, mean age 52 ± 18 years.
- Only 45% of patients received guideline-recommended antibiotics.
- Suboptimal adherence to IDSA guidelines for antibiotic therapy was observed.
Conclusions:
- Adherence to IDSA guideline-recommended antibiotic therapy for mild-to-moderate acute cholecystitis is suboptimal.
- Standardized protocols and ongoing provider education are needed to improve antibiotic stewardship.
- Quality improvement initiatives are crucial for optimizing care in acute biliary disease.
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