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February 1990

Predictive Factors for Bactibilia in Acute Cholecystitis

Author Affiliations

From the Departments of Surgery, Olive View Medical Center, Sylmar, Calif (Drs Thompson and Bennion), Sepulveda (Calif) Veterans Administration Medical Center (Drs Doty and Muller), and UCLA School of Medicine, Los Angeles, Calif (Drs Thompson, Bennion, Doty, and Muller), and the Department of Surgery, The Johns Hopkins University, Baltimore, Md (Dr Pitt).

Arch Surg. 1990;125(2):261-264. doi:10.1001/archsurg.1990.01410140139024

• Acute cholecystitis is well established as one of the high-risk factors bactibilia and wound infection. However, many patients with acute cholecystitis do not have bactibilia. Therefore, we analyzed 20 clinical and laboratory parameters in 49 patients with acute cholecystitis to determine which factor(s) predicted bactibilia. Twenty-one (42.9%) of 49 patients with pathologically proved acute cholecystitis had positive bile and/or gallbladder wall cultures. Univariate analysis suggested that a preoperative temperature greater than 37.3°C, a total serum bilirubin level greater than 8.6 μmol/L, and a white blood cell count greater than 14.1 × 109/L were the best predictors of bactibilia. Multifactorial analysis demonstrated that the 17 patients with zero or one predictive factor had a significantly lower chance of having bactibilia than the 32 patients with two or three predictive factors (6% vs 63%). We concluded that the culture status of patients with acute cholecystitis can be predicted preoperatively. We propose that patients with acute cholecystitis and zero or one of the predictive factors receive a single preoperative antibiotic dose. In patients with two or three predictive factors, antibiotics should be continued until culture data are available.

(Arch Surg. 1990;125:261-264)