title: Bactibilia and Antibiotic Resistance in Elective Cholecysctectomy: An Updated Ecologic Survey.
abstract: BACKGROUND
  The role of bactibilia as a risk factor for an unfavorable outcome during biliary disease or surgical procedures remains obscure. Our aim was to identify possible risk factors for bactibilia and their possible relations to complications after elective cholecystectomy. As secondary aims, composition and antibiotic resistance patterns were studied.
  
  
  METHODS
  Bile and gallbladder mucosa samples from 358 elective cholecystectomies were collected prospectively between June 2009 and June 2012. Ordinary microbiologic cultures and antibiograms were performed. All pre-operative factors associated with bactibilia were studied by stepwise logistic regression multivariable analysis.
  
  
  RESULTS
  The bacteria isolated most frequently from 103 positive cultures were Escherichia coli (21.3%), Enterococcus spp. (14.7%), and Enterobacter spp. (14.7%) with a global amoxicillin-clavulanic acid resistance rate of 53.7%. Age >65 y, male gender, previous instrumentation or disease of the biliary tract, and high American Society of Anesthesiologists score were independent risk factors. No correlation was found between bactibilia and surgical complications.
  
  
  CONCLUSIONS
  Although the influence of bactibilia in developing surgical complications is limited, its composition and the high rate of resistance can be influential enough to modify antibiotic treatment in biliary tract infections, especially in high-risk patients.
authors.affiliation: 1General Surgery Department, Germans Trias i Pujol Hospital/ Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Troyano Escribano
authors.affiliation: 2General Surgery Department, Vall d'Hebron Hospital/Universitat Autònoma de Barcelona, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Balibrea Del Castillo
authors.affiliation: 3Clinical Microbiology Department, Germans Trias i Pujol Hospital, Spain.
authors.forename: Sònia
authors.initials: S
authors.lastname: Molinos Abós
authors.affiliation: 3Clinical Microbiology Department, Germans Trias i Pujol Hospital, Spain.
authors.forename: Ausina Ruiz
authors.initials: AR
authors.lastname: Vicente
authors.affiliation: 1General Surgery Department, Germans Trias i Pujol Hospital/ Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Fernandez-Llamazares Rodriguez
authors.affiliation: 1General Surgery Department, Germans Trias i Pujol Hospital/ Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Oller Sales
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification*; D001431:Bacteriological Techniques; D001646:Bile / Q000382:microbiology*; D002763:Cholecystectomy; D024881:Drug Resistance, Bacterial; D005260:Female; D005704:Gallbladder / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult