ro13-9904 and Cholecystitis--Acute

To observe changes in surgeons' practice of antibiotic usage in patients with acute cholecystitis before and after the implementation of Tokyo Guidelines.. This retrospective, descriptive study was conducted at the Aga Khan University Hospital, Karachi, and comprised the medical records of all patients with the diagnosis of acute calculus cholecystitis who presented in 2009 and those who presented in 2014 after the implementation of Tokyo Guidelines. The major variables included patients' demographics, antibiotics used and surgical outcomes. SPSS 19 was used for data analysis.. Of the 356 patients, 96(27%) were treated in 2009 and 260(73%) in 2014. The overall mean age was 48.9±14 years. There were 185(52%) females and 171(48%) males. Comparison of the data from 2 years showed no difference in gender, American Society of Anaesthesiologists level, grade of acute cholecystitis and frequency of use of empiric antibiotics (p>0.05 each). However, there was significantly less use of combination therapy (p=0.00) and metronidazole (p=0.00) in 2014than in 2009. Interval cholecystectomy was significantly less practised in 2014 (p=0.03) resulting in shorter hospital stay (p=0.00). Despite improvement in antibiotic usage practices, post-operative infection rates remained the same in both the groups (p=0.58).. Implementation of Tokyo Guidelines not only greatly influenced but also standardised the choice of antibiotics in patients without compromising the infective and surgical outcomes.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Cefazolin; Ceftriaxone; Cholecystectomy; Cholecystectomy, Laparoscopic; Cholecystitis, Acute; Ciprofloxacin; Conversion to Open Surgery; Drug Therapy, Combination; Female; Gallstones; Humans; Length of Stay; Male; Metronidazole; Middle Aged; Pakistan; Practice Guidelines as Topic; Practice Patterns, Physicians'; Retrospective Studies; Severity of Illness Index; Surgeons; Surgical Wound Infection; Treatment Outcome

To evaluate the actual incidence of both microlithiasis and acute cholecystitis during treatment with intravenous ceftriaxone in a new rabbit model.. New Zealand rabbits were treated with intravenous ceftriaxone or saline for 21 days. Ultrasound monitoring of the gallbladder was performed every seven days until the 21st day when histopathology, immunohistochemistry for proliferating cell nuclear antigen (PCNA), pro-caspase-3 and CD68, liver enzyme biochemistry, and chromatography analysis of the bile and sediments were also performed.. All animals treated with ceftriaxone developed acute cholecystitis, confirmed by histopathology (P<0.05) and biliary microlithiasis, except one that exhibited sediment precipitation. In the group treated with ceftriaxone there was an increase in pro-caspase-3, gamma-glutamyl transpeptidase concentration, PCNA expression and in the number of cells positive for anti-CD68 (P<0.05). In the ceftriaxone group, the cholesterol and lecithin concentrations increased in the bile and a high concentration of ceftriaxone was found in the microlithiasis.. Ceftriaxone administered intravenously at therapeutic doses causes a high predisposition for lithogenic bile formation and the development of acute lithiasic cholecystitis.

Topics: Administration, Intravenous; Animals; Anti-Bacterial Agents; Ceftriaxone; Cholecystectomy; Cholecystectomy, Laparoscopic; Cholecystitis, Acute; Cholelithiasis; Disease Models, Animal; Gallbladder; Rabbits; Translational Research, Biomedical

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Cholecystectomy, Laparoscopic; Cholecystitis, Acute; Cholelithiasis; Humans; Male; Necrosis

Concomitant leptospirosis and scrub typhus is rare. The spectrum of clinical severity for both scrub typhus and leptospirosis ranges from mild to fatal. Acute pancreatitis and cholecystitis are infrequent complications in adult patients with either leptospirosis or scrub typhus. We report a case of leptospirosis and scrub typhus coinfection in a 41-year-old man presenting with acute acalculous cholecystitis, pancreatitis and acute renal failure. Abdominal computed tomography revealed edematous change of the gallbladder without intrahepatic or pancreatic lesions. The patient was successfully treated with doxycycline and ceftriaxone, and supportive management.

Topics: Acalculous Cholecystitis; Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Ceftriaxone; Cholecystitis, Acute; Doxycycline; Drug Therapy, Combination; Humans; Leptospira interrogans; Leptospirosis; Military Personnel; Orientia tsutsugamushi; Pancreatitis; Renal Insufficiency; Scrub Typhus; Tomography, X-Ray Computed