Acute Acalculous Cholecystitis associated bacteremia has worse outcomes

Javier Rincon; Rohit Rasane; Jose Aldana; Christina X Zhang; Ricardo Fonseca; Qiao Zhang; Kelly Marie Bochicchio; Obeid Ilahi; Grant Bochicchio

Acute Acalculous Cholecystitis (AAC) is an inflammation of the gallbladder in the setting of critical illness without gallstones, and represents 2-15 % of acute cholecystitis. Bacteremia is associated with increased morbidity and mortality in patients in the ICU. The incidence of bacteremia in acute calculous cholecystitis (ACC) has been described, however the incidence of bacteremia in AAC is not established.

We hypothesized that patients with Acute Acalculous Cholecystitis have higher bacteremia rates and worse outcomes.

Prospectively collected Acute Care Surgery institutional database from 2008 through 2018 was queried for patients diagnosed with Acute Cholecystitis using ICD 9 and 10 codes. Demographics, microbiology and outcomes were extracted. Only patients with positive blood cultures were included in the study. Based on the cultures, we defined 2 cohorts: AAC with bacteremia and ACC with bacteremia. Student’s T-test was used for continuous variables. Chi-square and Fisher exact test were used for categorical variables. Multivariable regression was applied. Statistical significance was set at p <0.05.

Of 323 patients with  Acute Cholecystitis , 57 (17.6%) patients had AAC and 266 (82.4%) had ACC. Of the 19 patients who had a blood culture, 11 (57.8%) were positive. Patients with positive blood culture had a mean age of  56.7 ± 15.3 and BMI  of 26.7 ± 4.9 . The incidence of bacteremia was significantly higher in AAC (6, 10.5% vs 5, 1.9 %, p=0.005) and the time of diagnosis of bacteremia from admission was similar in both groups(1.2  ± 1.1 vs 0.2 ± 0.5, p= 0.128). AAC patients with bacteremia were younger (53.8 ± 19.2 vs 60.2 ± 8, p= 0.021) and had a longer Intensive care unit (ICU) length of stay (LOS) (12.6 ± 7.2 vs 1.3 ± 2.1, p=0.006). However, there was no difference in mortality between groups (2, 33.3% vs 1, 20.0 % , p= 1.000). After adjusting for age, gender, BMI and Charlson comorbidity index, bacteremia in AAC patients was found to be an independent variable for increased ICU LOS ( OR 8.8; 1.7 - 15.9, p=0.024).

Incidence of bacteremia in patients with Acute Acalculous Cholecystitis is five times higher with 8 days longer ICU length of stay when compared to Acute Calculous Cholecystitis.