What is pyocholecystitis (inflammation of the gallbladder with pus)?

From the Guidelines

Piocolecisto treatment should prioritize laparoscopic cholecystectomy with antibiotic therapy for 4 days in immunocompetent patients, as recommended by the Italian Council for the optimization of antimicrobial use 1. The treatment of piocolecisto, a serious condition where the gallbladder becomes filled with pus due to an infection, requires a comprehensive approach.

• Hospitalization and antibiotics are essential components of treatment, with broad-spectrum coverage for gram-negative and anaerobic bacteria.
• Laparoscopic cholecystectomy is the definitive treatment and should be performed urgently, ideally within 24-72 hours of diagnosis.
• Antibiotic therapy should be started immediately upon diagnosis and continued until surgery and for a short course afterward, with a duration of 4 days in immunocompetent patients and up to 7 days in immunocompromised or critically ill patients 1.
• If surgery must be delayed or the patient is too unstable, percutaneous gallbladder drainage may be performed as a temporary measure, but it is inferior to cholecystectomy in terms of major complications for critically ill patients 1.
• Patients should be monitored for signs of sepsis, including fever, tachycardia, and hypotension.
• The Italian Council for the optimization of antimicrobial use recommends laparoscopic cholecystectomy with open cholecystectomy as an alternative, and antibiotic therapy for 4 days in immunocompetent patients 1.
• The 2017 WSES and SICG guidelines on acute calculous cholecystitis in the elderly population also support the use of laparoscopic cholecystectomy as the preferred treatment, even in elderly patients 1.
• Percutaneous cholecystostomy may be considered as a bridge to cholecystectomy in acutely ill (high-risk) elderly patients deemed unfit for surgery, but it should be adopted only in a subset of high-risk patients to convert them into moderate risk patients, more suitable for surgery 1.

From the Research

Definition and Treatment of Pyocolecist

• Pyocolecist, also known as pyogenic cholecystitis, is a condition where the gallbladder becomes inflamed due to a bacterial infection 2.
• The treatment of pyocolecist typically involves antibiotics and surgical intervention, such as laparoscopic cholecystectomy 2.

Antibiotic Treatment Options

• Piperacillin-tazobactam is a commonly used antibiotic combination for treating various infections, including those caused by extended-spectrum beta-lactamase (ESBL)-producing organisms 3, 4.
• Studies have shown that piperacillin-tazobactam can be effective in treating pyelonephritis caused by ESBL-producing organisms, and may be a reasonable alternative to carbapenems 4.
• Other antibiotic options, such as ertapenem, have also been shown to be effective in treating complicated infections, including those of the intra-abdominal and skin/skin-structure types 5.

Surgical Intervention

• Laparoscopic cholecystectomy is a common surgical procedure for treating gallbladder infections, including pyocolecist 2.
• The critical view of safety (CVS) is an important target of dissection during laparoscopic cholecystectomy, and can help reduce the risk of biliary injury 2.
• Photographic documentation during surgery can provide a reliable criterion for evaluating the safety of dissection and the achievement of CVS 2.