{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T03:06:02Z","timestamp":1766545562525,"version":"build-2065373602"},"reference-count":25,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,11,26]],"date-time":"2022-11-26T00:00:00Z","timestamp":1669420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Acute calculus cholecystitis (ACC) is increasing in frequency within an ageing population, in which biliary tract infection, including cholecystitis and cholangitis, is the second most common cause of sepsis, with higher morbidity and mortality rates. Patient\u2019s critical conditions, such as septic shock or anaesthesiology contraindication, may be reasons to avoid laparoscopic cholecystectomy\u2014the first-line treatment of ACC\u2014preferring gallbladder drainage. It can aid in patient\u2019s stabilization with also the benefit of identifying the causative organism to establish a targeted antibiotic therapy, especially in patients at high risk for antimicrobial resistance such as healthcare-associated infection. Nevertheless, a recent randomized clinical trial showed that laparoscopic cholecystectomy can reduce the rate of major complications compared with percutaneous catheter drainage in critically ill patients too. On the other hand, among the possibilities to control biliary sepsis in non-operative management of ACC, according to recent meta-analysis, endoscopic gallbladder drainage showed better clinical success rate, and it is gaining popularity because of the potential advantage of allowing gallstones clearance to reduce recurrences of ACC. However, complications that may arise, although rare, can worsen an already weak clinical condition, as happened to the high surgical-risk elderly patient taken into account in our case report.<\/jats:p>","DOI":"10.3390\/pathogens11121423","type":"journal-article","created":{"date-parts":[[2022,11,28]],"date-time":"2022-11-28T01:58:46Z","timestamp":1669600726000},"page":"1423","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Biliary Sepsis Due to Recurrent Acute Calculus Cholecystitis (ACC) in a High Surgical-Risk Elderly Patient: An Unexpected Complication"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1675-4547","authenticated-orcid":false,"given":"Giacomo","family":"Sermonesi","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessia","family":"Rampini","sequence":"additional","affiliation":[{"name":"General and Emergency Surgery Department, Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0925-9620","authenticated-orcid":false,"given":"Girolamo","family":"Convertini","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1720-0792","authenticated-orcid":false,"given":"Raffaele","family":"Bova","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4877-5759","authenticated-orcid":false,"given":"Nicola","family":"Zanini","sequence":"additional","affiliation":[{"name":"General and Emergency Surgery Department, Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo","family":"Bertelli","sequence":"additional","affiliation":[{"name":"General and Emergency Surgery Department, Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9523-1324","authenticated-orcid":false,"given":"Carlo","family":"Vallicelli","sequence":"additional","affiliation":[{"name":"General and Emergency Surgery Department, Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Favi","sequence":"additional","affiliation":[{"name":"General and Emergency Surgery Department, Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1891-6781","authenticated-orcid":false,"given":"Giacomo","family":"Stacchini","sequence":"additional","affiliation":[{"name":"General and Emergency Surgery Department, Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrico","family":"Faccani","sequence":"additional","affiliation":[{"name":"General and Emergency Surgery Department, Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicola","family":"Fabbri","sequence":"additional","affiliation":[{"name":"General and Emergency Surgery Department, Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5558-9965","authenticated-orcid":false,"given":"Fausto","family":"Catena","sequence":"additional","affiliation":[{"name":"General and Emergency Surgery Department, Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1093\/gastro\/gow015","article-title":"Nationwide trends of hospital admissions for acute cholecystitis in the United States","volume":"5","author":"Wadhwa","year":"2017","journal-title":"Gastroenterol. 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