Predictive factors for bactibilia in acute cholecystitis
J. E. Thompson Jr, R. S. Bennion, J. E. Doty, E. L. Muller and H. A. Pitt
Department of Surgery, Olive View Medical Center, Sylmar, CA 91342.
Acute cholecystitis is well established as one of the high-risk factors
bactibilla and wound infection. However, many patients with acute
cholecystitis do not have bactibillia. Therefore, we analyzed 20 clinical
and laboratory parameters in 49 patients with acute cholecystitis to
determine which factor(s) predicted bactibilla. Twenty-one (42.9%) of 49
patients with pathologically proved acute cholecystitis had positive bile
and/or gallbladder wall cultures. Univariate analysis suggested that a
preoperative temperature greater than 37.3 degrees C, a total serum
bilirubin level greater than 8.6 mumol/L, and a white blood cell count
greater than 14.1 x 10(9)/L were the best predictors of bactibilia.
Multifactorial analysis demonstrated that the 17 patients with zero or one
predictive factor had a significantly lower chance of having bactibilia
than the 32 patients with two or three predictive factors (6% vs 63%). We
concluded that the culture status of patients with acute cholecystitis can
be predicted preoperatively. We propose that patients with acute
cholecystitis and zero or one of the predictive factors receive a single
preoperative antibiotic dose. In patients with two or three predictive
factors, antibiotics should be continued until culture data are available.
