Predictive Factors for Bactibilia in Acute Cholecystitis

Thompson, Jesse E.; Bennion, Robert S.; Doty, Jeffrey E.; Müller, Elvira; Pitt, Henry A.

doi:10.1001/archsurg.1990.01410140139024

Cited by 54 publications

(54 citation statements)

References 12 publications

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“…14 The risk factors for bactibilia are well defined and include acute cholecystitis, common duct stones, emergency surgery, intraoperative findings and age >70 years. [15][16][17][18] It has been demonstrated that all patients found to have bactibilia at the time of cholecystectomy have at least one of these risk factors and that patients with uncomplicated gallstone disease do not show evidence of bactibilia. 6 The main aim of this study was to assess the effectiveness of a selective antibiotic prophylaxis policy limited to high risk patients undergoing LC with the development of port site infections as the primary endpoint.…”

Section: Yanni Mekhail Morris-stiffmentioning

confidence: 99%

A selective antibiotic prophylaxis policy for laparoscopic cholecystectomy is effective in minimising infective complications

Yanni

Mekhail

Morris‐Stiff

2013

annals

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INTRODUCTION It has been demonstrated previously that the identification of bactibilia during cholecystectomy is associated with the presence of one or more risk factors: acute cholecystitis, common duct stones, emergency surgery, intraoperative findings and age >70 years. Current evidence-based guidance on antibiotic prophylaxis during laparoscopic cholecystectomy (LC) is based on elective procedures and does not take into account these factors. The aim of this study was to assess the effectiveness of a selective antibiotic prophylaxis policy limited to high risk patients undergoing LC with the development of port site infections as the primary endpoint. METHODS One hundred consecutive patients undergoing LC under the care of a single consultant surgeon during a one-year period were studied prospectively. Data collected included patient demographics (age, sex) as well as details of the history of gallstone disease to determine those with complex disease and risk factors for bactibilia. A single dose of antibiotics (second generation cephalosporin and metronidazole) was administered on induction to patients with a risk factor present. Information relating to all radiologically or microbiologically confirmed infections was documented. RESULTS Eighty-four of the patients were female and the mean age was 47.7 ±16.0 years. Nineteen LCs were performed as emergencies and the remainder were elective procedures. A risk factor for bactibilia was present in 35 patients. A wound infection was identified in four cases, two of which were Staphylococcus aureus (one methicillin resistant), one was a coagulase negative Staphylococcus and one wound cultured a mixed anaerobic growth. Three of the infections occurred in patients receiving prophylaxis (2 staphylococcal and 1 anaerobic) at intervals of 7, 14 and 19 days respectively. One patient with a body mass index of 32kg/m 2 in the 'no prophylaxis' group developed a coagulase negative staphylococcal infection at 10 days. No intra or extra-abdominal abdominal infections were identified. CONCLUSIONS This study has demonstrated that restricting antibiotic prophylaxis to high risk patients has no detrimental effects in terms of increasing the rate of infections in those with no risk factors. Furthermore, the act of not prescribing to low risk patients will limit costs and the risk of adverse events. It will also reduce the risk of resistance and clostridial infections in this cohort.

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Section: Yanni Mekhail Morris-stiffmentioning

confidence: 99%

A selective antibiotic prophylaxis policy for laparoscopic cholecystectomy is effective in minimising infective complications

Yanni

Mekhail

Morris‐Stiff

2013

annals

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“…Bile is usually sterile in healthy individuals, however, in the presence of gallstones in the gallbladder or biliary ducts, it could be colonized with bacteria (bactobilia) (1,2). In symptomatic gallstone diseases, bactobilia has been reported in 20% -46% of the patients who undergo a cholecystectomy (3).…”

Section: Introductionmentioning

confidence: 99%

“…Obtaining bile culture during biliary surgery is mainly advised only in patients with some predisposing factors that could increase the risk of such infections. These risk factors include pyrexia, previous biliary instrumentation, previous biliary sepsis, bilioenteric anastomosis, immune suppression status, a palpable gallbladder, elevated WBC count, and elevated serum levels of alkaline phosphatase and old age (2,5,8,10,11). However, reports are still conflicting over the use of bile culture at biliary surgery (6,12).…”

Section: Introductionmentioning

confidence: 99%

Bactobilia Among Patients with Uncomplicated Cholelithiasis Undergoing Laparoscopic Cholecystectomy: The Risk Factors and Effects on Postoperative Infectious Complications

Ghahramani¹,

Jahromi²,

Pouladfar³

et al. 2017

Ann Colorectal Res

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Background: Determining the rate of bactibilia among patients under going laparoscopic cholecystectomy (LC) and its correlations with predisposing factors and postoperative infections, which help evaluate the need for prophylactic antibiotic. Methods: In this prospective study, 85 consecutive patients with uncomplicated cholelithiasis who underwent LC were enrolled from 2012 to 2013. Routine bile culture was done at the time of LC. Patients were divided into 2 groups, 1 with negative bile culture and another with bactibilia. Demographic and laboratory data were compared. Patients were followed up 10 days after their laparoscopy and 1 month after discharge to monitor the presence of infection. Results: A total of 7 cultures of bile were positive for bacteria (8.2 %). The patients' age was the sole factor with a significant relationship with the rate of bactobilia (P = 0.016). Within 10 days after surgery, fever and surgical site infection were detected in 10.6% of patients, which was not significantly different in the 2 groups. There were no complications in the 30-day follow-up. Conclusions: Detecting bactobilia with low frequency and the lack of correlation between bactobilia and postoperative infectious, complications did not support prescribing prophylactic antibiotic in respective patients. The older age was the sole predisposing factor for the development of bactobilia.

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“…Incidence gradually increases after 21 years and reaches peak in 5th and 6th decade women are more commonly affected than men in the ratio of 4:1. 1 Female sex, obesity, pregnancy, fatty foods, Crohn's disease, terminal ileal resection, gastric surgery, hereditary spherocytosis, sickle cell disease and thalassemia are associated with an increased risk for developing gall stones. Classic presenting symptoms of the majority of patients include stabbing (Colicky) pain in the right upper quadrant radiating to the back and to the shoulder.…”

Section: Introductionmentioning

confidence: 99%

“…Incidence gradually increases after 21 years and reaches peak in 5th and 6th decade women are more commonly affected than men in the ratio of 4:1. 1 The advent of laparoscopic surgery ushered in a new era in general surgery in the management of symptomatic gall stones. Open cholecystectomy is associated with a higher wound infection rate ranging from 1-21%.…”

mentioning

confidence: 99%

A Comparative Study to Assess the Role of Prophylactic Antibiotics in Elective Laparoscopic Cholecystectomy

Srikantaiah¹,

R²,

Aditya³

et al. 2015

jemds

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Benign biliary tract diseases are one of the most common surgical problems in the world. Cholelithiasis is rare in the first two decades of life. Incidence gradually increases after 21 years and reaches peak in 5th and 6th decade women are more commonly affected than men in the ratio of 4:1. 1 The advent of laparoscopic surgery ushered in a new era in general surgery in the management of symptomatic gall stones. Open cholecystectomy is associated with a higher wound infection rate ranging from 1-21%. The use of prophylactic antibiotics reduced this rate to 3%-7% and so has become common practice. Laparoscopic cholecystectomy is associated with smaller wounds and minimal tissue damage and therefore presumably a lower risk of wound infection. METHODOLOGYA prospective randomized control study involving a sample size of 52 patients (26 in the study group + 26 in the control group) was conducted over a period of 2 years. Chi square test of significance was used to test the difference in the proportion between the groups. To test whether there is significant difference in the means of 2 groups; Independent t-test/Mann Whitney test will be used. Statistical analysis was done using IBM SPSS 20 statistical software. RESULTSThe mean age in the study group was 43 years and the mean age in the control group was 44.42. Samples are age matched with P=0.421, Student 't' test. Incidence of Gallbladder disease was more in females in both the study group and the control group. Samples are gender matched with P=0.768. No SSI noted in the control group. 1 patient [3.8%] had SSI in the study group=1.000, Not significant, Fisher Exact test. E. coli was the organism isolated in the patient with SSI.P=1.000, Not significant, Fisher Exact test. Incidence of bile spillage was 7.7% in both the control group and the study group=1.000, Not significant, Fisher Exact test. DISCUSSIONThe use of prophylactic antibiotics in open cholecystectomy to reduce the rate of postoperative infective complications is considered to be the standard of practice. However, its use in laparoscopic cholecystectomy has been an area of conflicting opinion. CONCLUSIONIn conclusion, the results of this study have shown that avoiding prophylactic antibiotics in patients undergoing elective laparoscopic cholecystectomy increases the incidence of postoperative infective complication but not to a statistically significant degree.

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Predictive Factors for Bactibilia in Acute Cholecystitis

Cited by 54 publications

References 12 publications

A selective antibiotic prophylaxis policy for laparoscopic cholecystectomy is effective in minimising infective complications

A selective antibiotic prophylaxis policy for laparoscopic cholecystectomy is effective in minimising infective complications

Bactobilia Among Patients with Uncomplicated Cholelithiasis Undergoing Laparoscopic Cholecystectomy: The Risk Factors and Effects on Postoperative Infectious Complications

A Comparative Study to Assess the Role of Prophylactic Antibiotics in Elective Laparoscopic Cholecystectomy

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