SEPTIC ACUTE CHOLECYSTITIS

Background: Bacteremia occurs frequently in cholangitis, but the incid ence of bacteremia in acute cholecystitis has not previously been exam ined. Methods: Seventy-eight cases (46 men and 32 women; mean age, 63 +/- 10 years) of acute cholecystitis with positive blood cultures were analyzed for clinical manifestation, bacteriology, and what consequen ces ensued. Seventy-eight non-bacteremic cholecystitis patients, match ed for age and sex, served as the control group. Results: The prevalen ce of bacteremia in acute cholecystitis was 7.65% (78 of 1020). A sing le microorganism was isolated from the blood and bile in 87.2% and 27. 3%, respectively. The commonest organisms were Escherichia coli and Kl ebsiella pneumoniae. The source of bacteremia could be identified from the infected bile in 80% of cases. Compared with the non-bacteremia g roup, significant increases in liver biochemical test results (asparta te and alanine aminotransferases and bilirubin, and so forth), more co mplications (acute renal failure and septic shock), and higher mortali ty (9.0%) were found in the bacteremic group. Conclusion: Acute cholec ystitis is not often complicated by bacteremia, but when bacteremia is present, morbidity and death more consistently ensue.