title: Biliary tract surgery.
abstract: Postoperative wound infection rates after biliary tract surgery vary tremendously from 2% after uncomplicated cholecystectomy to 20% in series including many jaundiced patients. Almost all such infections arise from organisms growing in the diseased biliary tract, since infection rate of 1% are achieved when the bile is sterile. A history of cholangitis identifies only one third of the patients with infected bile, but four easily recognized clinical factors point to positive bile cultures in 60% to 75% of patients: (1) age over 70, (2) obstructive jaundice, (3) common duct stones without jaundice, and (4) emergent acute cholecystitis. These selected high-risk patients have postoperative infection rates of 20% to 27%. Preoperative administration of cephaloridine reduced this high rate of infection to 5% in a prospective randomized but not blinded trial. The initially reported experience of 84 patients has been extended to 140 and continues to confirm the efficacy of prophylactic antibiotics in selected high-risk patients. In contrast, there is no present evidence supporting the use of antibiotic prophylaxis in low-risk patients under 70 years of age undergoing uncomplicated cholecystectomy.
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001646:Bile / Q000382:microbiology; D001660:Biliary Tract Diseases / Q000601:surgery*; D002509:Cephaloridine / Q000627:therapeutic use; D002761:Cholangitis / Q000382:microbiology / Q000601:surgery; D002763:Cholecystectomy; D002764:Cholecystitis / Q000382:microbiology / Q000601:surgery; D002769:Cholelithiasis / Q000382:microbiology / Q000601:surgery; D002779:Cholestasis / Q000382:microbiology / Q000601:surgery; D006801:Humans; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D002509:Cephaloridine