PDF(Pubmed)
Abstract：
Acute cholecystitis is one of the most common surgical diseases, which may progress from mild to severe cases. When combined with bacteremia, the mortality rate of acute cholecystitis reaches up to 10-20%. The standard of care in patients with acute cholecystitis is early laparoscopic cholecystectomy. Percutaneous cholecystostomy or endoscopic procedures are alternative treatments in selective cases. Nevertheless, antibiotic therapy plays a key role in preventing surgical complications and limiting the systemic inflammatory response, especially in patients with moderate to severe cholecystitis. Patients with acute cholecystitis have a bile bacterial colonization rate of 35-60%. The most frequently isolated microorganisms are Escherichia coli, Klebsiella spp., Streptococcus spp., Enterococcus spp., and Clostridium spp. Early empirical antimicrobial therapy along with source control of infection is the cornerstone for a successful treatment. In these cases, the choice of antibiotic must be made considering some factors (e.g., the severity of the clinical manifestations, the onset of the infection if acquired in hospital or in the community, the penetration of the drug into the bile, and any drug resistance). Furthermore, therapy must be modified based on bile cultures in cases of severe cholecystitis. Antibiotic stewardship is the key to the correct management of bile-related infections. It is necessary to be aware of the appropriate therapeutic scheme and its precise duration. The appropriate use of antibiotic agents is crucial and should be integrated into good clinical practice and standards of care.
摘要：
急性胆囊炎是最常见的外科疾病之一。可能会从轻度进展到重度。当合并菌血症时，急性胆囊炎的死亡率高达10-20％。急性胆囊炎患者的护理标准是早期腹腔镜胆囊切除术。经皮胆囊造口术或内镜手术是选择性病例的替代疗法。然而，抗生素治疗在预防手术并发症和限制全身炎症反应方面发挥着关键作用，尤其是中度至重度胆囊炎患者。急性胆囊炎患者的胆汁细菌定植率为35-60％。最常见的微生物是大肠杆菌，克雷伯菌属。,链球菌属。,肠球菌属。,和梭菌属。早期经验性抗菌治疗以及感染源控制是成功治疗的基石。在这些情况下,抗生素的选择必须考虑一些因素(例如，临床表现的严重程度，如果在医院或社区获得感染的发作，药物渗入胆汁,和任何抗药性)。此外，在严重胆囊炎的情况下，必须根据胆汁培养物修改治疗方法。抗生素管理是正确处理胆汁相关感染的关键。有必要了解适当的治疗方案及其确切的持续时间。适当使用抗生素至关重要，应将其纳入良好的临床实践和护理标准。
