Wound sepsis after elective cholecystectomy. Restriction of prophylactic antibiotics to risk groups.

This prospective study of elective cholecystectomy investigated the frequency and type of bacteria in gallbladder bile at operation, the factors predicting the presence of bacteria in bile, and the relationship between bacteria in bile and subsequent wound sepsis. In 148 consecutive cases 23% of bile cultures were positive. The overall wound infection rate was 15%, but 91% of all wound infections occurred in patients with positive bile cultures. Eighty-five per cent of all positive bile cultures and 86% of all wound infections occurred in 37% of the patients, characterized by age over 60 years and/or a history of previous attacks of acute cholecystitis. We suggest that in elective cholecystectomy prophylactic antibiotics should be restricted to this group of patients to limit the use of antibiotics.