Developing A Surgical Rationale Of Bile Culture And Sensitivity To Guide Targeted Antibiotics In Laparoscopic Cholecystectomy in a Tertiary Care Hospital in Nepal

Abstract

Introduction

Laparoscopic cholecystectomy is the standard surgical treatment for symptomatic gallstone diseases and other benign gallbladder conditions. Traditionally, antibiotics have been used empirically in patients to lower the risk of post operative complications. Earlier routine use of antibiotic has now been replaced with single dose preoperative antibiotic. But, the emergence of anti-microbial resistant (AMR) organisms has raised concerns regarding the rampant use of antibiotics.

Material and Methods

This is a single-centered, prospective study done at department of GI and General surgery in KMCTH. Data collection was done between January 2025 to April 2025. There were 148 patients included in the study. Single dose ceftriaxone was given at induction. Bile was collected during the intraoperative period and culture was sent. Association of bile C/S with various preoperative and postoperative factors were analyzed. 

Results

In our study, bile culture was positive in 11 of 148 patients (7.4%). Escherichia coli and Klebsiella pneumoniae were the predominant isolates (72%). No significant association of the bile culture colonization was observed with either age, gender or BMI. Those who were immunocompromised had higher bile culture microbial growth rates (21.1% vs. 5.4 %; p = 0.036). Signficantly higher culture growth rates were also noted in infective cases (29.4%), cases with drain placement intraoperatively (28.6%),  and those with hospital stay >3 days (26.7%). Among the cases that had growth on bile culture, 100% of the organisms were resistant to the routinely used prophylactic antibiotic.

Conclusion

Routine bile contamination and bile culture positivity in laparoscopic cholecystectomy is low. While prophylactic antibiotics may not be universally required, selective use is justified in high-risk groups such as immunocompromised patients or those with infective pathology, drain placement, or prolonged hospitalization.