Impact of Remote Cholecystectomy on Outcomes in Pseudomonas aeruginosa Bloodstream Infections
Overview
This retrospective cohort study of 336 adults with Pseudomonas aeruginosa bloodstream infections (PABSI) found no significant differences in antimicrobial resistance, length of blood culture positivity, or mortality between patients with or without a remote cholecystectomy. Mortality remained high overall, with 30.1% 90-day mortality, and liver disease was identified as a significant risk factor for increased mortality.
Background
Bloodstream infections (BSIs) are a major public health concern with high mortality and economic burden, particularly when caused by gram-negative bacteria like Pseudomonas aeruginosa (Pa). Pa BSIs are associated with high antimicrobial resistance and mortality rates ranging from 20% to 70%. Recent animal studies identified the gallbladder as a reservoir for Pa expansion, raising questions about whether gallbladder removal (cholecystectomy) affects clinical outcomes or resistance patterns in human PABSI cases.
Data Highlights
Parameter
Retained Gallbladder (n=262)
Cholecystectomy (n=74)
Findings
Length of Blood Culture Positivity
Not significantly different
Not significantly different
No difference between groups
90-day Mortality
~30.1%
~30.1%
No difference between groups
In-hospital Mortality
Similar rates
Similar rates
No difference between groups
Antimicrobial Resistance Profile
No robust differences
No robust differences
Similar resistance patterns
Mortality in Patients with Liver Disease
Higher mortality
Higher mortality
Significantly increased 90-day mortality
Key Findings
No significant difference in length of blood culture positivity between patients with or without remote cholecystectomy.
90-day and in-hospital mortality rates were similar regardless of gallbladder status, with an overall 90-day mortality of 30.1%.
Antimicrobial resistance profiles of P. aeruginosa isolates did not differ significantly between groups.
Patients with underlying liver disease had significantly higher 90-day mortality compared to those without liver disease.
Remote cholecystectomy did not influence clinical outcomes or antimicrobial resistance patterns in PABSI.
Clinical Implications
These findings suggest that remote cholecystectomy does not impact antimicrobial resistance or mortality outcomes in patients with PABSI. Clinicians should focus on managing comorbid conditions such as liver disease, which significantly increase mortality risk. Despite advances in antipseudomonal therapies, mortality remains high, underscoring the need for vigilant clinical management and early effective treatment.
Conclusion
Remote cholecystectomy does not affect antimicrobial resistance or clinical outcomes in Pseudomonas aeruginosa bloodstream infections. Mortality remains substantial, particularly in patients with liver disease, highlighting ongoing challenges in managing PABSI.
References
Bachta et al. 2023 -- Gallbladder as a Reservoir for Pseudomonas aeruginosa in Bloodstream Infection
