From Guidelines to Practice: Closing the Antibiotic Stewardship Gap in Acute Cholecystitis

Acute cholecystitis affects approximately 200,000 individuals annually in the United States and may result in significant morbidity if not appropriately managed. The Infectious Diseases Society of America (IDSA) recommends cefazolin, ceftriaxone, or cefuroxime as first-line therapy for mild-to-moderate community-acquired biliary infections; however, adherence to these guidelines remains variable. Within our institution's Emergency General Surgery process improvement program, antibiotic stewardship in acute biliary disease was identified as an opportunity for quality optimization. We performed a retrospective review of the EGS Registry at our military treatment facility from 2017 to 2021. Adult patients with mild-to-moderate acute cholecystitis were included. A total of 143 patients met the inclusion criteria; 62% were female, with a mean age of 52 ± 18 years. Guideline-recommended antibiotics were administered to 45% of patients. Adherence to IDSA guideline-recommended antibiotic therapy for mild-to-moderate acute cholecystitis was suboptimal at our institution, highlighting the need for standardized protocols and ongoing provider education to improve antibiotic stewardship.