Calculous cholecystitis (>90%) refers to inflammation of the gallbladder as a complication of gallstone disease, causing RUQ pain, fever, leukocytosis and often, secondary infection
Acalculous cholecystitis (5-10%) results from gallbladder stasis and ischemia in the absence of gallstones, and is typically seen in hospitalized patients
Surgical/gastroenterology consult for definitive management (e.g. cholecystectomy)
Significant bilirubin and ALP elevations not common in uncomplicated disease
Biliary cultures are negative in most patients with gallstones, but are useful for those with complicated or acalculous cholecystitis
Blood cultures in severely ill and health care associated cholecystitis
Procalcitonin (PCT) not usually useful
May have biliary colic but no features of infection (e.g. no fever or ↑ WBC)
Infection not extending beyond the gallbladder
Infection extends beyond the gallbladder (e.g. perforation, gangrenous cholecystitis, fistula), or
Localized infection but cholecystectomy contraindicated
Usual Organisms
Less Common Organisms
Organisms of Interest in IAI