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Elective Cholecystectomy: The Role of Biliary Bacteriology and Administration of Antibiotics

Elective Cholecystectomy: The Role of Biliary Bacteriology and Administration of Antibiotics Abstract • One hundred patients who underwent elective cholecystectomy were studied prospectively to define the accuracy of an intraoperative Gram's stain procedure in discovering the presence of bactibilia, the apparent necessity for prophylactic use of antibiotics, and the resulting septic complication rate. Antibiotics were used for prophylaxis in 48 patients and were withheld from 52. Intraoperative Gram's stain procedure and culture were used in all cases. Bactibilia was present in 23% of the group and was accurately predicted by Gram's stain in 87% of all. The only septic complication was a stitch abscess in one patient in the group that received antibiotics. The presence of bactibilia does not seem to be associated with an increased incidence of infectious complications in elective cholecystectomy for chronic cholecystitis. Routine use of Gram's stain should detect the presence of Gram-positive rods (Clostridium), thus allowing early initiation of appropriate treatment. (Arch Surg 1981;116:537-540) References 1. Pyrtek LJ, Bartus SH: Clostridium welchii infection complicating biliary-tract surgery . N Engl J Med 1962;266:689-693.Crossref 2. Turner FP: Fatal Clostridium welchii septicemia following cholecystectomy . Am J Surg 1964;108:3-6.Crossref 3. Chetlin SH, Elliott DW: Biliary bacteremia . Arch Surg 1971;102:303-307.Crossref 4. Keighley MRB, McLeish AR, Bishop HM, et al: Identification of the presence and type of biliary microflora by immediate Gram stains . Surgery 1977;81:469-472. 5. McLeish AR, Keighley MRB, Bishop HM, et al: Selecting patients requiring antibiotics in biliary surgery by immediate Gram stains of bile at operation . Surgery 1977;81:473-477. 6. Keighley MRB, Drysdale RB, Quoraishi AH, et al: Antibiotic treatment of biliary sepsis . Surg Clin North Am 1975;55:1379-1390. 7. Wolloch Y, Feigenberg Z, Zer M, et al: The influence of biliary infection on the postoperative course after biliary tract surgery . Am J Gastroenterol 1977;67:456-462. 8. Cox JL, Helfrich LR, Pass HI, et al: The relationship between biliary tract infections and postoperative complications . Surg Gynecol Obstet 1978;146:233-236. 9. Lykkegaard Nielsen M, Justesen T: Anaerobic and aerobic bacteriological studies in biliary tract disease . Scand J Gastroenterol 1976;11:437-446. 10. Fukunaga FH: Gallbladder bacteriology, histology and gallstones . Arch Surg 1973;106:169-171.Crossref 11. Scott AJ, Khan GA: Origin of bacteria in bileduct bile . Lancet 1967;2:790-792.Crossref 12. Beinfield MS, Hayes RL: Use of intraoperative Gram stain during cholecystectomy . Am J Surg 1979;137:773-774.Crossref 13. McLeish AR, Strachan CJL, Powis SJA, et al: The influence of biliary disease on the excretion of cefazolin in human bile . Surgery 1977;81:426-430. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Elective Cholecystectomy: The Role of Biliary Bacteriology and Administration of Antibiotics

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References (14)

Publisher
American Medical Association
Copyright
Copyright © 1981 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1981.01380170031005
Publisher site
See Article on Publisher Site

Abstract

Abstract • One hundred patients who underwent elective cholecystectomy were studied prospectively to define the accuracy of an intraoperative Gram's stain procedure in discovering the presence of bactibilia, the apparent necessity for prophylactic use of antibiotics, and the resulting septic complication rate. Antibiotics were used for prophylaxis in 48 patients and were withheld from 52. Intraoperative Gram's stain procedure and culture were used in all cases. Bactibilia was present in 23% of the group and was accurately predicted by Gram's stain in 87% of all. The only septic complication was a stitch abscess in one patient in the group that received antibiotics. The presence of bactibilia does not seem to be associated with an increased incidence of infectious complications in elective cholecystectomy for chronic cholecystitis. Routine use of Gram's stain should detect the presence of Gram-positive rods (Clostridium), thus allowing early initiation of appropriate treatment. (Arch Surg 1981;116:537-540) References 1. Pyrtek LJ, Bartus SH: Clostridium welchii infection complicating biliary-tract surgery . N Engl J Med 1962;266:689-693.Crossref 2. Turner FP: Fatal Clostridium welchii septicemia following cholecystectomy . Am J Surg 1964;108:3-6.Crossref 3. Chetlin SH, Elliott DW: Biliary bacteremia . Arch Surg 1971;102:303-307.Crossref 4. Keighley MRB, McLeish AR, Bishop HM, et al: Identification of the presence and type of biliary microflora by immediate Gram stains . Surgery 1977;81:469-472. 5. McLeish AR, Keighley MRB, Bishop HM, et al: Selecting patients requiring antibiotics in biliary surgery by immediate Gram stains of bile at operation . Surgery 1977;81:473-477. 6. Keighley MRB, Drysdale RB, Quoraishi AH, et al: Antibiotic treatment of biliary sepsis . Surg Clin North Am 1975;55:1379-1390. 7. Wolloch Y, Feigenberg Z, Zer M, et al: The influence of biliary infection on the postoperative course after biliary tract surgery . Am J Gastroenterol 1977;67:456-462. 8. Cox JL, Helfrich LR, Pass HI, et al: The relationship between biliary tract infections and postoperative complications . Surg Gynecol Obstet 1978;146:233-236. 9. Lykkegaard Nielsen M, Justesen T: Anaerobic and aerobic bacteriological studies in biliary tract disease . Scand J Gastroenterol 1976;11:437-446. 10. Fukunaga FH: Gallbladder bacteriology, histology and gallstones . Arch Surg 1973;106:169-171.Crossref 11. Scott AJ, Khan GA: Origin of bacteria in bileduct bile . Lancet 1967;2:790-792.Crossref 12. Beinfield MS, Hayes RL: Use of intraoperative Gram stain during cholecystectomy . Am J Surg 1979;137:773-774.Crossref 13. McLeish AR, Strachan CJL, Powis SJA, et al: The influence of biliary disease on the excretion of cefazolin in human bile . Surgery 1977;81:426-430.

Journal

Archives of SurgeryAmerican Medical Association

Published: May 1, 1981

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