Microbiology and Antibiotic Prophylaxis in Laparoscopic Cholecystectomy

Phrompirun Wattanawiggid, MD, Achara Chankaew, MD, Petch Kasetsuwan, MD, Panot Yimcharoen, MD. Bhumibol Adulyadej Hospital, Bangkok, Thailand.

Background: The use of antibiotics in laparoscopic cholecystectomy (LC) is well established. Type of antibiotics, prophylaxis purpose, and period after surgery varies significantly among surgeons. The purpose of this study was to determine the microorganism in bile of patients who underwent LC related to symptom of gallstones.

Materials and Methods: Twenty-six patients with symptomatic gallstones undergoing elective LC in our institution were prospectively reviewed. The characteristic of patient included demographic data, microorganism, and length of stay, type of operation, indication for surgery, pathological finding, antibiotic type and reason of antibiotic use. We sent bile from gallbladder for culture in all cases. Patients were divided by indication for surgery into 2 groups; group 1: symptomatic gallstones without previous biliary tract infection and group 2: gallstone with history of previous biliary tract infection.

Results: From May 2013 to September 2013, 26 patients (19 F, 7 M) had mean age 60+13.97 years (28-80). Overall rate of uneventful LC was 76.92 %. We had 5 cases accidental ruptured gallbladder during surgery and one case converted to open surgery. Between group 1 (17 patients) and group 2 (9 patients), rate of positive bile culture was not statistically different (29% and 44%, p =0.44). The common organisms of bile culture were Escherichia coli (55.26%) and Klebsiella pneumonia (22.22%). An antibiotic that has been used in this study was third generation cephalosporin (65.38%) with prophylaxis reason was 53.86% and the other for treatment. No wound complication occurred in this study. Mean length of stay was 3 days after surgery.

Conclusions: Based on our study, there was no significant difference in the rate of positive bile culture between the two groups. The third generation cephalosporin was the common antibiotic for the prevention and treatment of wound infection following elective LC. Escherichia coli was the most common organism that was found in bile culture among these patients.

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