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 IV loading dose followed by maintenance for target trough of 15-20 ug/mL
See dosing nomogram

If patient cannot be dosed using nomogram contact Pharmacy.

AND

Piperacillin-tazobactam 3.375 gm IV q6h

OR

Meropenem 500 mg IV q6h or 1 gm IV q8h

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

Vancomycin IV loading dose followed by maintenance for target trough of 15-20 ug/mL
See dosing nomogram

If patient cannot be dosed using nomogram
contact Pharmacy.

AND

Ciprofloxacin 400mg IV q12h

AND

Gentamicin 7 mg/kg IV q24h

May require calculation of adjusted body weight if patient obese; see drug monograph