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Timely treatment of acute cholecystitis and cholangitis is necessary to prevent unwanted outcomes. Quiz Ref IDThe most important aspect of treatment is source control, but antimicrobial treatment is a necessary and important adjunct. The primary goal of antimicrobial therapy is to limit the systemic septic response and local inflammation and prevent surgical site infection and intrahepatic abscess formation.1 Increasing antimicrobial resistance, particularly owing to extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae, complicates selection of anti-infective agents, making knowledge of local epidemiological data important. Provision of antimicrobial therapy calls for a balance between ensuring adequate treatment of the pathogen(s) and minimizing risk of collateral damage due to excessive antimicrobial administration. Stratifying antimicrobial use based on severity of infection and whether it is a community-acquired or health care–associated infection, deescalating therapy once definitive culture results are available, and limiting duration of therapy when appropriate promote optimal antimicrobial use.
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Corresponding Author: John E. Mazuski, MD, PhD, Department of Surgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8109, St Louis, MO 63110-1093 (email@example.com).
Published Online: July 3, 2019. doi:10.1001/jamasurg.2019.2169
Conflict of Interest Disclosures: Dr Mazuski has received personal fees from Allergan, Bayer Pharmaceuticals, GlaxoSmithKline, Melinta Therapeutics, Pfizer Pharmaceuticals, and Tetraphase Pharmaceuticals as well as grants and personal fees from Merck & Co; served as President of the Surgical Infection Society, task force leader, and first author of the 2017 Surgical Infection Society revised guidelines for the treatment of intra-abdominal infection; and was a coauthor of the 2015 Surgical Infection Society Study to Optimize Peritoneal Infection Therapy trial, the 2017 World Society of Emergency Surgery guidelines on intra-abdominal infection, the revised Surviving Sepsis guidelines published in 2017, and the 2017 US Centers for Disease Control and Prevention guideline for the prevention of surgical site infection. No other disclosures were reported.
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