Selective antibiotic prophylaxis in biliary surgery

Wound infections and septic complications are among the most frequent complications of biliary surgery. Such complications frequently occur in patients with infected bile. The presence of infected bile is predictable and can be expected in patients defined as high-risk patients. Short-term perioperative antibiotic prophylaxis was shown to be effective on an unselective basis by several authors. In this study of 231 consecutive biliary procedures, antibiotic prophylaxis was used on a selective basis in high-risk patients only. The high-risk patients were 55% of the entire group. Perioperative prophylaxis was given for 24 hours using four gentamicin injections starting two hours prior to anesthesia. Selective prophylaxis was shown to be highly effective reducing the wound infection rate to 3.5% in this group, compared to 12.5% in a similar group without prophylaxis. The selective use of prophylaxis was shown to be highly cost-effective as compared to the group without prophylaxis as well as reported groups of unselective prophylaxis in biliary surgery.