Bile Microbiology and Risk Factors Associated with Antibiotic Resistance Patterns in Patients Taken to Laparoscopic Cholecystectomy: A Prospective Cohort Study

Objectives: To evaluate bile culture microbiology and factors associated with resistance patterns in patients taken to laparoscopic cholecystectomy to better guide empiric antibiotic therapy. Methods: Prospective cohort study with a logistic regression model in a middle-income public hospital network of two institutions. Inclusion criteria were patients taken to laparoscopic cholecystectomy over 18 years of age due to benign biliary disease without other concomitant surgical procedures taken to bile culture and antibiogram testing to evaluate bile culture positivity considered as a “resistant pattern”. Results: 226 cultures tested positive for at least one microorganism, and 218 were included in the study. Overall, bile cultures classified as resistant were associated with age, comorbidities, acute signs of cholecystitis, and longer antibiotic therapy. Bile microorganisms found consisted mostly of Enterobacteriaceae. In the logistic regression model, previous ERCP, Charlson comorbidity index and duration of antibiotic therapy yielded as statistically significant (p 0.03, p 0.003 and 0.004, respectively) for presenting resistant patterns. Conclusions: Patients taken to laparoscopic cholecystectomy have a higher probability of being resistant to empirical therapy for managing acute cholecystitis if they had a higher Charlson comorbidity index, previous ERCP and longer preoperative antibiotic therapy, and thus intraoperative cultures should be considered for guided antibiotic therapy. Trial registration number: NCT06314399.