Routine or selective antibiotic prophylaxis in biliary surgery

ABSTRACT

The microbial flora of the bile were prospectively studied in 229 patients admitted for biliary surgery. None of those patients received any antibiotic before the bile specimens were obtained. Positive bile cultures were found in 89 patients [30%]. Aerobic organisms alone were isolated in 90% of those patients. The incidence of wound infection was significantly higher in the positive bile group, and serous postoperative complications occurred only in this group. To rationalize the use of prophylactic antibiotics in biliary surgery and to identify the groups of patients at risk, we correlated the positive bile cultures with certain clinical, biochemical, and radiological factors such as presence of cholangitis, dilatation of biliary ducts, diabetes, and age. The study concluded that prophylactic antibiotics should be administered to patients with one or more of the risk factors studies. This policy products 82% of the patients at risk and spares 70% of the patients with sterile bile from receiving antibiotics unnecessarily