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Infection complicating cholecystectomy.

It is important to attempt clinical selection of patients who will benefit from antibiotic prophylaxis during biliary tract operations. Of equal importance is exclusion of patients in whom the risk of adverse effects outweigh the potential benefits. Using clinical criteria defined by Chetlin and Elliott, we have tested a method of defining these patients in our clinical setting. From the size of the sample in this prospective randomized study we can report trends as follows: 1) The incidence of postoperative infection was two times higher in the high-risk group. 2) The incidence of positive bile culture was greater in the high-risk group. 3) Prophylactic antibiotic treatment decreased the incidence of infection in both groups. 4) Radiographic status of the gallbladder is not correlated with subsequent positive bile cultures or incidence of infection. 5) Common duct exploration is associated with a significant increase in incidence of postoperative wound infection. The conclusions of this study substantiate the efficacy of incorporating clinical criteria to determine patients at high risk of developing wound infections.