There are some interesting aspects we can comment on regarding the study by Tocchi et al. First, the authors present a very small group of patients with a problem that is frequently encountered all over the world. We should be reading about hundreds of patients receiving antibiotics and hundreds not receiving them instead of such small groups. Second, the infection rate seems exceedingly high in this selected group of patients (many exclusion criteria) who underwent elective, minimally invasive surgery. (Perhaps more so in the control group, but it is also high in the protected group.) One wonders not necessarily about the usefulness of prophylactic antibiotics but about the surgical care protocols at the center where the study was performed. Perhaps there were several surgeons involved, maybe drains were being left, etc. Third, it is strange that in a selected population without acute cholecystitis the authors found bacterial contamination in more than 40% of bile samples. We do not know if the biliary tract was manipulated before surgery.
Orozco H, Mercado MA. The Need for Antibiotic Prophylaxis in Elective Laparoscopic Cholecystectomy—Invited Critique. Arch Surg. 2000;135(1):70. doi:10.1001/archsurg.135.1.70