The significance of bacteriological findings at cholecystectomy

The value of routine bacterial culture and gram staining of bile intraoperatively was investigated in 84 patients undergoing cholecystectomy. A positive bile culture was found in five of eight patients with an acute cholecystitis and in three of five patients with stones in the common bile duct, but in only nine of 66 patients with chronic cholecystitis without a common duct stone (14%). None of the patients with a normal gallbladder wall or cholesterolosis were bacteria-positive. Immediate microscopy of bile showed positive results in eight of 17 culture-positive bile specimens. As the majority of strains isolated from bile were aerobes sensitive to ampicillin and trimethoprim-sulphamethoxazole, any of these antibiotics can safely be administered intraoperatively to patients belonging to the risk group (acute cholecystitis, common bile duct stone). Immediate microscopy of bile is an unrealiable method of limited value and is not recommended for routine use.