Not Just Complicated Cholecystitis—Beware of Risk Factors!

Abstract

Background: The association between individual risk factors and a higher incidence of multi-drug-resistant infections may transform a common surgical condition such as accute cholecystitis into a life-threatening situation. Case Presentation: A 75-year-old male with multiple comorbidities including active chemotherapy presented to the emergency department with fever and acute upper right quadrant pain. He presented low blood pressure but no other systemic inflammatory response syndrome (SIRS) parameters. Resuscitation with intravenous fluids and a first dose of antibiotics was prescribed, with new blood tests ordered for the next morning. The patient was re-evaluated by the next day's team and his clinical condition and blood results had worsened, so he was taken to the operating room. A cholecystectomy was performed, abdominal fluid was sent for culture, and empirical antibiotic (meropenem) was prescribed for his severe condition. Cultures were positive for extended spectrum b-lactamase (ESBL) Escherichia coli and Klebsiella pneumoniae, adequately treated empirically. The patient remained in the intensive care unit for 48 hours but the rest of his post-operative course was uneventful and he was discharged a week later. Conclusion(s): We report a case of complicated cholecystitis, a common condition in the emergency department, but in a patient with multiple risk factors and infection with a multi-resistant pathogen, that can lead to a lifethreatening situation if an early source control and adequate antibiotic therapy are not performed immediately.