Acalculous Cholecystitis

Note

Bile stasis in critically ill patients can lead to inflammation and secondary infection.

Relatively common cause of fever, leukocytosis +/- abdominal tenderness in critically ill patients (M > F).

Palpable gallbladder and jaundice more common than calculous cholecystitis.

Pathogens similar to calculous cholecystitis, but can also be caused by opportunistic pathogens in immunosuppressed patients.

Dx by U/S.

Treatment requires prompt source control - cholecystectomy vs. cholecystostomy - Send anaerobic cultures and STAT gram stain.

Vancomycin 25-30mg/kg IV load (max 2g) followed by 15mg/kg IV q12h maintenance for a target trough of 15-20µg/mL

AND

Piperacillin-tazobactam 3.375 gm IV q6h

OR

Meropenem 500 mg IV q8h or 1 gm IV q8h

OR

Cefepime 2 gm IV q8-12h

NOTE: anaerobic coverage not necessary unless patient has biliary-enteric anastamosis (in which case add metronidazole)

Vancomycin 25-30mg/kg IV load (max 2g) followed by 15mg/kg IV q12h maintenance for a target trough of 15-20µg/mL

AND

Ciprofloxacin 400mg IV q12h

AND

Gentamicin 5mg/kg IV q24h target trough <1mcg/mL

OR

Aztreonam 2g IV q24h