A Prospective Clinical Study On Gallbladder Bile Bacteria And Perioperative Use Of Prophylactic Antibiotics In Elective Laparoscopic Cholecystectomy

Objective: To investigate gallbladder bile bacteria infection and its antibiotic resistance and study prospectively the perioperative use of prophylactic antibiotics in low-risk elective laparoscopic cholecystectormy.Methods: 300 patients undergoing elective laparoscopic cholecystctomy were randomized into 1 of 3 treatment arms: Group A (100 patients) received no prophylactic antibiotics; Group B (99 patients) received a single intravenous dose of ceftriaxone 2g at induction of general anesthesia; Group C (101 patients) received postoperatively a total of three 2g doses of intraveneous ceftriaxone. A gallbladder bile sample for bacteria culture and susceptiblility test was withdrawn intraoperatively for all patients. Postoperative wound infection, intra-abdominal infection or abscess, pneumonia and lower urinary tract infection were compared with each other.Results: 299 patients were performed successfully under laparoscopy and one case was converted to open cholecystectomy . 3 cases of bile leakage occurred postoperatively. The conversion case and 3 bile leakage cases were excluded from the statistical analysis: 2 cases from group A ,1 case from group B and 1 case from group C. 300 bile samples were collected for bacteria culture and susceptiblility test. Among 282 cases of gallstone cultures were positive in 68 (24.1%), while cultures were negative among all 18 cases of gallbladder polyp. 58 strains (69.0%) of gram-negative bacilli and 26 strains (31.0%) gram-positive cocci were isolated. The first five strains were escherichia coli (27.4%), klebsiella (15.5%), staphylococcus (13.1%), enterococcus 9.5% and pseudomonas aeruginosa (8.3%). The susceptible rates of the isolated bacteria were as follows: ampicillin,31%, cefazolin, 70.2%,the second quinolones, 82.1% ~ 84.5%, the third cephalosporins, 91.7%~96.4%. Group A (98 patients) had 1 superficial surgical site infection and 1 lower urinary tract infection with a 1% wound infection rate and an overall infection rate of 2%; Group B (98 patients) had 1 superficial surgical site infection, 1 postoperative pneumonia and 2 low urinary tract infection with a 1% wound infection rate and an overall infection rate of 4.1%; Group C (100 patients) had 2 superficial surgical site infection, 2 postoperative pneumonia and 1 lower urinary tract infection with a 2% wound infection rate and an overall infection rate of 5%. All patients were followed-up for 3~18 months. There were no intra-abdominal infection and abscess. Comparison of the above data shows no statistically significant difference between the three groups for wound infection, intra-abdominal infection , postoperative pneumonia, lower urinary tract infection and overall infection.Conclusion: Most gallbladder bile isolates were gram-negative, but there tended to be more gram-positive isolates. The resistant rates of most isolates are increasing year by year. Low-risk elective laparoscopic cholecystectomy carries a low risk of wound infection and the other infections. No use of prophylactic antibiotics does not increase the rate of postoperative infection in low-risk elective laparoscopic cholecystectomy.