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Hepatobiliary I
PTU-088 The microflora of bile after intraoperative aspiration of the gallbladder during cholecystectomy for acute cholecystitis
  1. M S J Wilson,
  2. K Seymour
  1. General Surgery, North Tyneside General Hospital, North Shields, UK

Abstract

Introduction Emergency cholecystectomy for the management of acute cholecystitis is now common. In order to facilitate this procedure it can be helpful to decompress the gallbladder by aspirating its contents. The benefit of gallbladder aspiration in the elective setting is however unclear.1 2 It is important to be aware of the likely microflora of bile in patients undergoing emergency cholecystectomy to facilitate the use of appropriate targeted antibiotics. The aim of this study was to establish the prevalence of intraoperative gallbladder aspiration during acute cholecystectomy and to determine the microflora after microscopy and culture.

Methods A retrospective analysis of patients who underwent emergency cholecystectomy for acute cholecystitis over an 18-month period (July 2010 to January 2012) identified from PAS data. Cross referencing with microbiology electronic database for microscopy and culture findings from gallbladder aspiration samples.

Results 124 patients (36 male, 88 female, age range 18–90 years) underwent cholecystectomy during the study period. 29 (23.4%) patients underwent intraoperative aspiration of gallbladder contents, of which 20 (69.0%) had no organisms seen at microscopy and 14 (48.3%) grew no organisms after incubation in culture medium. Abstract PTU-088 table 1 outlines the organisms isolated in the remaining 15 patients; four grew an isolated organism and 11 grew more than one organism and also details the antibiotic profile following culture.

Abstract PTU-088 Table 1

Microorganisms isolated after culture of gallbladder aspirates and antibiotic profile (S = sensitive, R = resistant)

Conclusion In order to facilitate emergency cholecystectomy for acute cholecystectomy it is often necessary to decompress the gallbladder by aspirating its contents. In our case series this was necessary in 23% of patients. Almost half of aspirates were found to be sterile. In the remainder, the most common organism isolated after culture is Escherichia coli, whch is usually resistant to amoxicillin, but sensitive to tazocin. However, the sensitivity of E coli to augmentin is less clear and surgeons should be aware of this when initiating antibiotic prophylaxis for acute cholecystitis.

Competing interests None declared.

References 1. Ezer A, Nursal TZ, Colakoglu T, et al. The impact of gallbladder aspiration during elective laparoscopic cholecystectomy: a prospective randomized study. AJS 2008;196:456–9.

2. Calik A, Topaloglu S, Topcu S, et al. Routine intraoperative aspiration of gallbladder during laparoscopic cholecystectomy. Surg Endosc 2007;21:1578–81.

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