Predictive factors associated with bile culture positivity: a model development and diagnostic test accuracy study

Area of Science:

• Hepatobiliary Surgery
• Infectious Disease Management
• Clinical Prediction Modeling

Background:

• The optimal use of antibiotics in benign biliary pathology remains unclear.
• This study addresses the need for better patient stratification regarding positive bile cultures.
• Antibiotic stewardship is crucial in surgical settings.

Purpose of the Study:

• To develop and validate a predictive model for identifying patients with benign biliary disease at low risk of positive bile cultures.
• To optimize antibiotic administration in preoperative and perioperative settings.
• To improve clinical decision-making for cholecystectomy patients.

Main Methods:

• Prospective cohort study of 703 adult patients undergoing cholecystectomy.
• Intraoperative bile cultures were obtained, with positive cultures as the primary outcome.
• Demographic, clinical, and paraclinical variables were analyzed to build a multivariable prediction model.

Main Results:

• The incidence of positive bile cultures was 32.1%.
• A multivariable model including age, ERCP, and time from admission to procedure demonstrated fair discrimination (c-statistic 0.75).
• Low-risk patients identified by the model had high sensitivity (92%) and effectively ruled out positive cultures (negative likelihood ratio 0.21).

Conclusions:

• The developed predictive model is effective in assessing bile culture positivity risk.
• It can guide decisions to withhold antibiotics in low-risk patients preoperatively and perioperatively.
• This aids in antibiotic stewardship for cholecystectomy procedures.