Routine or selective antibiotic prophylaxis in biliary surgery

ABSTRACT

The microbial flora of the bile were studied in 141 patients admitted for biliary surgery. Positive bile cultures were found in 30 [21.3 percent] patients. Gram negative organisms were isolated in 28 [93 percent] patients. The incidence of wound infection was higher in the positive bile culture 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 factors such as presence of acute cholecystitis, choledocholithiasis, diabetes and old age. The study concluded that prophylactic antibiotics should be administered to the patients with one or more of the risk factors studied. This policy protects 41.7 percent of the patients at risk, and spares 89.2 percent of the patients with sterile bile from receiving antibiotics unnecessarily