HPB SO30 - Evaluation of efficiency of Co-amoxiclav as an empiric antimicrobial treatment for grade II/ III acute cholecystitis

Abstract Background Acute cholecystitis is associated with considerable mortality. The risk of mortality ranges between 2.4% to 8.4% according to severity. The main line of managing patient presenting with grade II/ III acute cholecystitis is source control through insertion of cholecystostomy drain (if patient is not suitable for emergency cholecystectomy) and anti-microbial treatment. Tokyo 2018 guidelines recommends against use of Co-Amoxiclav as an empiric antimicrobial therapy for cases of acute cholecystitis as most common organism isolated is E. Coli. The aim of this study is to evaluate the efficiency of Co-amoxiclav as an empiric antimicrobial treatment for grade II/ III acute cholecystitis. Method The medical records were searched retrospectively for patient presented with acute severe cholecystitis grade II/ III who treated with cholecystostomy drain insertion as a temporary measure during 2020 and 2021. The culture and sensitivity (C&S) of cholecystostomy drain aspirate at time of insertion of the drains were reviewed to determine the type of appropriate antimicrobial therapy. The results were analysed using both best and worst case scenario to find about the efficacy of Co-Amoxiclav as an empiric antimicrobial treatment. Results 105 sample of cholecystostomy drain aspirate sent for culture and sensitivity, 27 samples were resistant to co-amoxiclav (25%), while 22 samples were sensitive to co-amoxiclav(20.9%) . 56 of samples (53.1%) showed no mention of testing of Co-Amoxiclav. On further analysis on best case scenario basis, the sensitivity to co-amoxiclav will be 74% considering all the 56 non-tested samples are sensitive to co-amoxiclav. While on worst case scenario, the sensitivity to co-amoxiclav will be 74% considering all the 56 non-tested samples are resistant to co-amoxiclav. Conclusion Use of co-amoxiclav as an empirical antimicrobial treatment for cases of grade II/ III acute cholecystitis is associated with considerable antimicrobial resistance ranges from 25% in the best case scenario and 79% in worst case scenario. The most common organism isolated from these samples was E.coli. These results are in complete agreement with Tokyo 2018 guidelines, which states that Co-amoxiclav is associated with more than 20% resistance.