Acta clinica Croatica, Vol. 61. No. 2, 2022.
Original scientific paper
https://doi.org/10.20471/acc.2022.61.02.01
The Use of Microbiological and Laboratory Data in the Choice of Empirical Antibiotic Therapy in Patients Undergoing Laparoscopic Cholecystectomy – the Role of Local Antibiograms
Fuad Pašić
; Department of Surgery, Tuzla University Clinical Center, Tuzla, Bosnia and Herzegovina
Samir Delibegović
orcid.org/0000-0003-0525-3288
; Department of Surgery, Tuzla University Clinical Center, Tuzla, Bosnia and Herzegovina; Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
Abstract
Antibiotic therapy is indicated during acute cholecystitis. However, in the treatment
of uncomplicated cholelithiasis, prophylactic use of antibiotics is controversial. Microbiological
and laboratory data are the basis for the choice of antibiotic treatment. However, monitoring and updating
local antibiograms is important because they ensure effective therapy in the given clinical environment.
The study included 110 consecutive patients who underwent laparoscopic cholecystectomy,
divided into the group of uncomplicated cholelithiasis (n=60) and the group of acute cholecystitis
(n=50). Preoperative data included age, sex, body mass index, leukocytes, C-reactive protein, and ultrasound
examination. Bile samples for bacteriological testing were obtained under aseptic conditions
during the surgery. Cultures were evaluated for aerobic, anaerobic and fungal organisms using routine
tests. After the surgery, gallbladder specimens were sent for histopathological examination. In the
group of uncomplicated cholelithiasis, 6/60 positive samples were found, and in the group of acute
cholecystitis, there were 25/50 positive microbiological findings. Citrobacter sp. and Enterococcus faecalis
predominated in the group of uncomplicated cholelithiasis, and Escherichia coli, Enterococcus faecalis,
Proteus mirabilis and Citrobacter sp. in the group of acute cholecystitis. Antibiotics were administered
to 49/50 patients with acute cholecystitis and to 32/60 patients with uncomplicated cholelithiasis. Cefazolin
was the most frequently used antibiotic and also the most resistant antibiotic. To conclude, the
administration of antibiotics in elective patients is not justified. The results of this study indicate that
third-generation cephalosporin or ciprofloxacin + metronidazole should be administered in mild and
moderate acute cholecystitis, and fourth-generation cephalosporin + metronidazole in severe acute
cholecystitis in this local setting. The appropriate use of antibiotic agents is crucial and should be
integrated into good clinical practice and standards of care.
Keywords
Acute cholecystitis; Laparoscopic cholecystectomy; Bile; Antibiotic prophylaxis
Hrčak ID:
284668
URI
Publication date:
1.8.2022.
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