Cholecystitis--etiology and treatment--microbiological aspects

Area of Science:

• Gastroenterology
• Infectious Diseases
• Surgical Infections

Background:

• Acute cholecystitis is primarily a chemical inflammation, frequently complicated by bacterial translocation from the gut.
• Common aerobic bacteria include Escherichia coli, Klebsiella, and Streptococcus faecalis, while anaerobes like Bacteroides fragilis and clostridia are also prevalent.
• Mixed bacterial infections are common, with bactibilia (bacteria in bile) occurring in at least 60% of early acute cholecystitis cases, particularly in the elderly and those with recurrent disease.

Purpose of the Study:

• To review the role of bacterial infections and bactibilia in acute cholecystitis.
• To evaluate the efficacy of antimicrobial treatment and prophylaxis in managing infectious complications.
• To provide guidance on appropriate antimicrobial strategies for acute cholecystitis.

Main Methods:

• Literature review of studies on acute cholecystitis, bactibilia, and antimicrobial therapy.
• Analysis of bacterial prevalence in acute cholecystitis, focusing on aerobic and anaerobic organisms.
• Evaluation of the impact of antimicrobial prophylaxis on infectious complications.

Main Results:

• Bactibilia is strongly associated with infectious complications in acute cholecystitis.
• Antimicrobial treatment, while not sterilizing bile, is favored in febrile cases, especially in the elderly, to prevent sepsis.
• Preoperative antimicrobial prophylaxis significantly reduces infectious complications, even with persistent bactibilia.

Conclusions:

• Short courses of preoperative antimicrobial prophylaxis (1-2 days, possibly a single dose) are effective in reducing infectious complications.
• A combination of broad-spectrum beta-lactam antibiotics and nitroimidazoles offers appropriate and safe coverage for prophylaxis.
• Antimicrobial choice should consider local resistance patterns and clinical experience.