Impact of Remote Cholecystectomy on Clinical Outcomes Following Pseudomonas aeruginosa Bloodstream Infection: A Retrospective Cohort Study

PurposeMortality associated with Pseudomonas aeruginosa bloodstream infection (PABSI) remains high despite advances in clinical care and therapeutics. In a recent study using mice to model PABSI, the gallbladder (GB) was identified as a reservoir for bacterial expansion. Furthermore, bile exposure has been linked to increased antimicrobial resistance (AMR). Therefore, we asked whether patients with retained gallbladders might suffer from more antimicrobial resistant P. aeruginosa (Pa) infections, extended culture positivity, and worsened clinical outcomes. MethodsRetrospective cohort study of adults hospitalized over a five-year period with PABSI. PABSI cases were defined as patients with [≥] 1 positive Pa bacterial culture from the blood. Patients were categorized as either those retaining a gallbladder (no cholecystectomy) or those without (cholecystectomy). Cholecystectomy was defined as a history of cholecystectomy [≥] 1 year prior to the index episode of PABSI. Inferential statistics were used to identify associations between remote cholecystectomy and antimicrobial resistance profile, length of blood culture positivity, and in-hospital and 90-day mortality. ResultsThe final study population included 336 patients, 262 (78%) with retained gallbladder and 74 (22%) without. We observed no difference in 90-day or in-hospital mortality between groups. Overall, composite 90-day mortality was 30.1%. Furthermore, no robust differences were observed in the antimicrobial resistance profile of Pa isolates between the groups. ConclusionsIn our study, neither PABSI AMR pattern nor clinical outcome was affected by remote cholecystectomy. However, we do demonstrate that mortality for patients with PABSI in the modern era remains high despite advances in anti-pseudomonal therapeutics.