A 48-year-old woman presents with several hours of acute right upper quadrant pain, low grade fever, and nausea and vomiting. Which of the following statement(s) is/are true concerning her diagnosis and management?

d. Appropriate antibiotic coverage should include coverage for gram-negative aerobes

Acute cholecystitis occurs in about 10% to 20% of patients with symptomatic gallstones. Although the clinical manifestations of biliary colic and acute cholecystitis may overlap and clinical distinction is often difficult, persistence of pain beyond a matter of hours and fever would strongly suggest acute cholecystitis. The primary events in the development of acute cholecystitis are chemical in nature with bacterial infection playing a minor role in the genesis of the disease. In normal healthy subjects without gallstones, incidence of positive bile cultures is essentially zero. In contrast, between 30 and 70% of patients with the clinical diagnosis of acute cholecystitis will have positive bile cultures. The incidence of positive bile cultures who undergo cholecystectomy increases significantly with age. Septic complications continue to be a significant source of morbidity after cholecystectomy for acute cholecystitis. These septic complications can best be prevented by the judicious use of appropriate antimicrobial agents. The goal of antimicrobial therapy should be establishment of adequate serum and tissue levels of antibiotic rather than selection of an antibiotic that is excreted into the bile. Given the bacteriology that is typical in patients with uncomplicated cholecystitis, an appropriate antibiotic regimen should provide for adequate coverage of gram-negative aerobes. Although technically more difficult, laparoscopic cholecystectomy can be completed safely in the majority of patients with acute cholecystitis. Significant experience and good judgment, however, is essential in insuring optimal results. Laboratory data are often nonspecific with acute cholecystitis. Mild jaundice may be present in up to 20% of patients and is typically due to inflammation as opposed to bile duct obstruction secondary to stones.