Are We Using the Adequate Antibiotic Prophylaxis in Biliary Surgeries?

Abstract

under biliary surgery and the risk factors leading to bacterobilia. Methods: Retrospective study from 2014 to 2019. Surgeries involving biliary tree were included. Prior biliary procedures and personal risk factors were analyzed. Univariate analysis using Student t test, Fisher and chi2; relative risk was measured and multivariate logistic regression was performed. Statistical significance level set at 0,05. Results: Out of 86 biliary surgeries bacterobilia was documented in 45; 40 had some kind of biliary procedure prior final surgery (p=0,001), with a relative risk of 5,66 (CI 95% 1,8-17,3). When type of procedure was analyzed, percutaneous drainage showed no difference but ERCP had higher rate of bacterobilia (RR 3,14, CI95% 1,29-7,58). When previous cholangitis was developed bacterobilia was also higher (RR 2,53, CI 95% 1,04-6,1); but when patients were operated while receiving antibiotic treatment the rate of bacterobilia was lower (p=0,05). Age, sex, BMI, alcoholism, smoking, diabetes, inmunosupressive treatment, level of bilirubin, hemoglobin or albumin showed no difference. The presence of bacterobilia was not associated to higher rates of wound infection or other postoperative complications. In multivariate analysis only being operated under antibiotic treatment showed statistical significance (p= 0,041). Conclusion: Instrumentation of the biliary tree prior surgery should be performed in selective patients. Surgery during antibiotic treatment is feasible and reduces the risk of bacterobilia.