Impact of Remote Cholecystectomy on Clinical Outcomes Following Pseudomonas aeruginosa Bloodstream Infection
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By
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Hanna K Bertucci
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Lyndsey R Heise
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Anne Kurze
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Michael P Angarone
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Alan R Hauser
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Marc H Scheetz
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Susheel Reddy
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Kelly E R Bachta
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November 12, 2025
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Clinical Scorecard: Effects of Remote Cholecystectomy on Clinical Outcomes in Patients with Pseudomonas aeruginosa Bloodstream Infections
At a Glance
| Category | Detail |
|---|
| Condition | Pseudomonas aeruginosa bloodstream infection (PABSI) |
| Key Mechanisms | Gallbladder as a reservoir for bacterial expansion; bile exposure linked to antimicrobial resistance |
| Target Population | Hospitalized adults with PABSI |
| Care Setting | Hospital inpatient setting |
Key Highlights
- Remote cholecystectomy (≥1 year prior) does not affect antimicrobial resistance profiles or clinical outcomes in PABSI patients.
- Overall 90-day mortality for PABSI remains high (~30%) despite advances in antipseudomonal therapies.
- Liver disease in PABSI patients is associated with significantly higher 90-day mortality.
Guideline-Based Recommendations
Diagnosis
- Define PABSI by ≥1 positive blood culture for Pseudomonas aeruginosa in patients with systemic infection signs.
Management
- Prompt and appropriate antipseudomonal antibiotic therapy is critical due to high mortality and antimicrobial resistance.
- Consider patient comorbidities such as liver disease when assessing prognosis.
Monitoring & Follow-up
- Monitor blood culture positivity duration; no difference observed related to gallbladder status.
- Assess for antimicrobial resistance patterns to guide therapy.
Risks
- High mortality risk associated with PABSI, especially in patients with liver disease.
- Multidrug-resistant and difficult-to-treat resistance phenotypes are common in PABSI.
Patient & Prescribing Data
Adults hospitalized with Pseudomonas aeruginosa bloodstream infection
Despite newer antimicrobial agents, mortality remains high; no impact of prior cholecystectomy on resistance or outcomes.
Clinical Best Practices
- Early identification and treatment of PABSI with effective antipseudomonal agents.
- Recognize liver disease as a significant risk factor for poor outcomes in PABSI.
- Do not alter management solely based on presence or absence of gallbladder in remote cholecystectomy patients.
References
