Abstract
The bile is infected in 31% of patients undergoing an operation for biliary disease and these patients have a significantly greater risk of developing wound sepsis and septicaemia than patients with sterile bile. Prophylactic antibiotics which achieve satisfactory serum rather than high bile levels have been shown to reduce the morbidity of biliary operation. However, only patients with infected bile benefit from prophylactic chemotherapy. Patients with infected bile can be satisfactorily identified by preoperative duodenal aspiration, operative Gram staining of bile, or clinical presentation. The high-risk patients requiring preoperative antibiotic cover include anyone over 70 years of age, jaundiced patients, those requiring emergency operation, patients with recent rigors, anyone having had previous biliary operations, and patients known to have choledocholithiasis.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- Acocella G., Mattiussi R., Nicolis F. B., Pallanza R., Tenconi L. T. Biliary excretion of antibiotics in man. Gut. 1968 Oct;9(5):536–545. doi: 10.1136/gut.9.5.536. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Blumgart L. H., Cotton P. B., Burwood R., Lawrie B., Salmon P., Davies G. T., Beales J. S., Skirving A., Read A. E. Endoscopy and retrograde choledochopancreatography in the diagnosis of the jaundiced patient. Lancet. 1972 Dec 16;2(7790):1269–1273. doi: 10.1016/s0140-6736(72)92648-7. [DOI] [PubMed] [Google Scholar]
- Flemma R. J., Flint L. M., Osterhout S., Shingleton W. W. Bacteriologic studies of biliary tract infection. Ann Surg. 1967 Oct;166(4):563–572. doi: 10.1097/00000658-196710000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jones E. A., Sherlock S., Crowley N. Bacteraemia in association with hepatocellular and hepatobiliary disease. Postgrad Med J. 1967 Mar;43(Suppl):7–11. [PubMed] [Google Scholar]
- Keighley M. R., Drysdale R. B., Quoraishi A. H., Burdon D. W., Alexander-Willians J. Antibiotics in biliary disease: the relative importance of antibiotic concentrations in the bile and serum. Gut. 1976 Jul;17(7):495–500. doi: 10.1136/gut.17.7.495. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Keighley M. R., Flinn R., Alexander-Williams J. Multivariate analysis of clinical and operative findings associated with bilary sepsis. Br J Surg. 1976 Jul;63(7):528–531. doi: 10.1002/bjs.1800630709. [DOI] [PubMed] [Google Scholar]
- Keighley M. R., Wilson G., Kelly J. P. Fatal endotoxic shock of biliary tract origin complicating transhepatic cholangiography. Br Med J. 1973 Jul 21;3(5872):147–148. doi: 10.1136/bmj.3.5872.147. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mason G. R. Bacteriology and antibiotic selection in biliary tract surgery. Arch Surg. 1968 Oct;97(4):533–537. doi: 10.1001/archsurg.1968.01340040029002. [DOI] [PubMed] [Google Scholar]
- Mortimer P. R., Mackie D. B., Haynes S. Ampicillin levels in human bile in the presence of biliary tract disease. Br Med J. 1969 Jul 12;3(5662):88–89. doi: 10.1136/bmj.3.5662.88. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Robson M. C., Bogart J. N., Heggers J. P. An endogenous source for wound infections based on quantitative bacteriology of the biliary tract. Surgery. 1970 Sep;68(3):471–476. [PubMed] [Google Scholar]
- Sales J. E., Sutcliffe M., O'Grady F. Cephalexin levels in human bile in presence of biliary tract disease. Br Med J. 1972 Aug 19;3(5824):441–443. doi: 10.1136/bmj.3.5824.441. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Scott A. J. Bacteria and disease of the biliary tract. Gut. 1971 Jun;12(6):487–492. doi: 10.1136/gut.12.6.487. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Stratford B. C. The treatment of acute cholecystitis and other diseases with rifamycin diethylamide (rifamide). Med J Aust. 1966 Jan 1;1(1):7–9. [PubMed] [Google Scholar]
- Watson J. F. The role of bacterial infection in acute cholecystitis: a prospective clinical study. Mil Med. 1969 Jun;134(6):416–426. [PubMed] [Google Scholar]