Impact of Discordant Antibiotics on Outcomes After Percutaneous Cholecystostomy for Acute Cholecystitis: A Retrospective Analysis of 184 PCC Patients

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Abstract
Background: Antibiotic discordance in patients undergoing percutaneous cholecystostomy (PCC) for acute cholecystitis (AC) remains a debated issue. While empiric therapy aims to cover the most common pathogens, source control via PCC may play a greater role in clinical outcomes. This study evaluates the impact of discordant antibiotic treatment on patient outcomes. Methods: This single-center retrospective cohort study analyzed 184 PCC procedures performed for AC between 2018 and 2020. Patient demographics, bile cultures, empirical antibiotic regimens, and clinical outcomes were analyzed, with a focus on the impact of discordant antibiotic coverage. Results: Of the 184 PCC patients, 128 (69.5%) had positive bile cultures, with Escherichia coli (34%), Enterococcus (24%), and Klebsiella (14%) being the most common pathogens. Resistant bacteria were identified in 28% of patients. Despite 42% (n = 78) receiving discordant antibiotics, there were no significant differences in mortality, complications, or length of hospital stay between the discordant and concordant groups. However, the 90-day readmission rate was significantly higher in the discordant group (64.1% vs. 47.2%, p = 0.023). Conclusions: Although discordant antibiotic treatment did not impact short-term outcomes, it was associated with a significantly higher rate of readmission. These findings suggest that PCC may be the primary driver of acute management; however, inadequate antimicrobial coverage might influence long-term recurrence.

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