Postoperative wound infection rates after biliary tract surgery vary tremendously from 2% after uncomplicated
cholecystectomy to 20% in series including many jaundiced patients. Almost all such
infections arise from organisms growing in the diseased biliary tract, since
infection rate of 1% are achieved when the bile is sterile. A history of
cholangitis identifies only one third of the patients with infected bile, but four easily recognized clinical factors point to positive bile cultures in 60% to 75% of patients: (1) age over 70, (2)
obstructive jaundice, (3) common duct stones without
jaundice, and (4) emergent
acute cholecystitis. These selected high-risk patients have postoperative
infection rates of 20% to 27%. Preoperative administration of
cephaloridine reduced this high rate of
infection to 5% in a prospective randomized but not blinded trial. The initially reported experience of 84 patients has been extended to 140 and continues to confirm the efficacy of prophylactic
antibiotics in selected high-risk patients. In contrast, there is no present evidence supporting the use of
antibiotic prophylaxis in low-risk patients under 70 years of age undergoing uncomplicated
cholecystectomy.