title: Antibiotic resistance pattern and clinical outcomes in acute cholecystitis: 567 consecutive worldwide patients in a prospective cohort study.
abstract: BACKGROUND
  Postoperative complications for cholecystitis and cholelithiasis are important causes of intra-abdominal infections (IAIs). There have been no previous reports on intra-abdominal bacteriology in complicated IAIs due to acute cholecystitis (AC).
  
  
  METHODS
  The data came from two prospective multicenter observational cohort studies (CIAO: the "Complicated Intra-Abdominal infection Observational" study and CIAOW: the "Complicated Intra-Abdominal infection Observational World" study) which involved 116 medical institutions worldwide with consecutive patients who underwent surgery, interventional drainage or conservative treatment for AC.
  
  
  RESULTS
  Of 567 patients, there were 291 males (51.3%). The mean and median age were 62.5 and 64 years respectively. 546 (96.3%) had community-acquired and 21 (3.7%) patients had health-care-associated infections. 267 bacteria were isolated, 21 (7.8%) were resistant bacteria. No resistant Fungi or Anaerobes were isolated. 4 out of the 21 resistant bacteria were health-care-associated. Multivariate analysis demonstrated health-care associated infection (p = 0.03), inadequacy of empiric antimicrobial therapy (p = 0.003) and recent antimicrobial therapy (p < 0.0001) to be factors associated with resistant bacteria. The factors associated with mortality were presence of generalized peritonitis (p < 0.0001) and inadequate source control (p = 0.018). The factors associated with ICU admission were severe sepsis (p < 0.0001), generalized peritonitis (p = 0.001), concomitant malignancy (p = 0.037), inadequate source control (p = 0.025), delay in initial intervention (p < 0.0001) and age over 70 years (p = 0.025).
  
  
  CONCLUSIONS
  The number of infection caused by Extended Spectrum Beta-Lactamase bacteria (ESBL+) and Klebsiella pneumoniae Carbapenemase-producer bacteria (KPC+) were common in acute cholecystitis and in community-acquired infections. An adequate empirical antimicrobial therapy was fundamental to reduce bacterial resistance and to improve outcomes.
authors.affiliation: Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy. Electronic address: federico.coccolini@gmail.com.
authors.forename: Federico
authors.initials: F
authors.lastname: Coccolini
authors.affiliation: Unit of General and Emergency Surgery, Macerata Hospital, Macerata, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Sartelli
authors.affiliation: Unit of General and Emergency Surgery, Parma University Hospital, Parma, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Catena
authors.affiliation: Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Montori
authors.affiliation: Unit of General Surgery, Maggiore Hospital, Bologna, Italy.
authors.forename: Salomone
authors.initials: S
authors.lastname: Di Saverio
authors.affiliation: Letterkenny Hospital and the Donegal Clinical Research Academy, Donegal, Ireland; University College Hospital, Galway, Ireland.
authors.forename: Michael
authors.initials: M
authors.lastname: Sugrue
authors.affiliation: Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Ceresoli
authors.affiliation: Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Manfredi
authors.affiliation: Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Ansaloni
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D041881:Cholecystitis, Acute / Q000188:drug therapy* / Q000382:microbiology; D004352:Drug Resistance, Microbial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents
keywords: Acute cholecystitis; Antibiotic; Antimicrobial; Bacteriology; Infection; Peritonitis; Spectrum; Therapy