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Cholecystitis, acute

Cholecystitis, acute

Empiric Antimicrobial Therapy

Community-acquired, mild
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  • Mild cases do not meet the criteria of grade II-III (moderate to severe) acute cholangitis
  • Grade I (mild) cases can also be defined as acute cholecystitis in a healthy patient with no organ dysfunction and mild inflammatory changes in the gallbladder, making cholecystectomy a safe and low-risk operative procedure

Community-acquired, moderate
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Moderate cases are defined as at least 1 of the following conditions:

  • WBC >18,000/mm³
  • palpable tender mass in RUQ
  • duration >72h
  • marked local inflammation (gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, emphysematous cholecystitis)

Community-acquired, severe
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Severe cases are defined as at least 1 of any of the following conditions:

  • hypotension requiring dopamine ≥5 μg/kg/min, or any dose of norepinephrine
  • disturbance of consciousness
  • PaO2 / FiO2 <300
  • oliguria or serum creatinine >2.0 mg/dL
  • prothrombin time (INR) >1.5
  • platelet <100,000 /mm³