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No Post-Op Antibiotics Uncomplicated Cholecystectomy — SCE Infectious Diseases MCQ

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EasyAntimicrobial StewardshipNo Post-Op Antibiotics Uncomplicated CholecystectomySCE Infectious Diseases

A 60-year-old woman develops acute calculous cholecystitis. She is taken to surgery for laparoscopic cholecystectomy. Intraoperatively, bile culture grows Klebsiella pneumoniae and Enterococcus faecalis. The cholecystectomy is uncomplicated. Does she need post-operative antibiotics?

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Correct answer: E — For uncomplicated cholecystitis with successful cholecystectomy and no biliary spillage/perforation, post-operative antibiotics are NOT routinely required — intraoperative source control (cholecystectomy) is definitive

NICE NG104 and WSES guidelines recommend that for uncomplicated cholecystitis (no perforation, no biliary peritonitis) treated with successful cholecystectomy, post-operative antibiotics are NOT routinely indicated. The surgery itself provides definitive source control. Antibiotics may be warranted pre-/perioperatively for severe/gangrenous cholecystitis, perforation, or immunocompromised patients. The positive bile cultures in uncomplicated cholecystitis do not mandate antibiotics post-source control — this is an important antibiotic stewardship point.

Reference: NICE NG104 2014 – Gallstone disease; WSES 2020 – Cholecystitis