title: Antibiotic advice based on an intra-operative Gram-stain during cholecystectomy.
abstract: Intra-operative microscopy of the bile was performed during cholecystectomy in 335 patients. Based on the results, individual antibiotic advice was given. Bacteria were seen in the Gram-stained smear from 96 patients of whom 86 had a positive culture. In five patients a negative Gram-stain correlated with a positive culture (sensitivity 94.5%, specificity 95%, positive predictive value 89.5% and negative predictive value 97.5%). In only four patients (1.2%) did the antibiotic advice turn out to be wrong. Eight patients (2.4%) had signs of postoperative infection: one after wrong antibiotic advice, one who did not have prophylaxis because of false negative microscopy, four who did not have prophylaxis for clinical reasons but who had positive Gram-stains, and two despite apparently appropriate antimicrobial prophylaxis. An intra-operative Gram-stain as a guide to individual antibiotic advice given by a medical microbiologist during cholecystectomy is recommended.
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D001424:Bacterial Infections / Q000517:prevention & control; D001646:Bile / Q000382:microbiology*; D002763:Cholecystectomy / Q000009:adverse effects; D005188:False Negative Reactions; D005260:Female; D005840:Gentian Violet; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010619:Phenazines; D013530:Surgical Wound Infection / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; C035863:Gram's stain; D010619:Phenazines; D005840:Gentian Violet