Biliary Tract Microflora in Patients Undergoing Cholecystectomy for Acute Biliary Tract Disease: An Analysis of the Effect of Bile Spillage and Microbiology on Outcomes

IntroductionBile spillage (BS) is common during laparoscopic cholecystectomy (LC) and has been shown to be associated with an increased risk of surgical site infection (SSI). We hypothesized that positive bile cultures (PBCs) increase the risk of postoperative complication including SSI.MethodsA retrospective chart review was conducted including all patients older than 18 years undergoing urgent LC from January to September 2019. Charts were reviewed for the index admission and postoperative visits. We compared those who had PBCs with those who did not. Our primary endpoint was the rate of SSI. Univariate analysis and multivariate logistic regression were used to identify predictors of SSI.Results272 patients underwent LC. Indications for operation included acute cholecystitis (62.5%), symptomatic cholelithiasis (12.5%), and other indications (25%). Bile was spilled in 191 patients (70.2%). Positive bile cultures were obtained in 78 of 249 (31.3%) patients and were associated with preoperative endoscopic retrograde cholangiopancreatography (ERCP; 44% vs 26%, <i>P</i> = 0.014) and drain placement (50% vs 28.9%, <i>P</i> = 0.031). Eleven postoperative complications were noted, including 6 SSI (2.2%). Positive bile culture (3.8% vs 1.8%, <i>P</i> = 0.38), BS (3.1% vs 0%, <i>P</i> = 0.18), ERCP (1.4% vs 2.5%, <i>P</i> = 1.0), and drain placement (6.7% vs 1.7%, <i>P</i> = 0.13) were not associated with SSI. Multivariate analysis demonstrated that positive cultures were not predictive of complication (<i>P</i> = 0.13) or SSI (<i>P</i> = 0.91).ConclusionPositive bile cultures are not inherently associated with an increased risk of SSI and therefore should not lead to ongoing postoperative antibiotic therapy.