MICROORGANISMS IN BILE - PREVENTABLE CAUSE OF SEPSIS AFTER BILIARY SURGERY

Abstract

The bile is infected [with bacteria] in 31% of patients undergoing an operation for biliary disease; these patients have a significantly greater risk of developing wound sepsis and septicemia than patients with sterile bile. Prophylactic antibiotics which achieve satisfactory serum rather than high bile levels reduce the morbidity of biliary operation. 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 yr of age, jaundiced patients, those requiring emergency operation, patients with recent rigors, anyone having had previous biliary operations and patients known to have choledocholithiasis.