Objective: We aimed to evaluate whether Gram stain results from smear preparations of bile are useful in determining the optimal perioperative antimicrobial agents. Summary of Background Data: Surgical site infections (SSIs) are common complications in emergency cholecystectomy. Methods: A total of 185 patients who underwent emergency cholecystectomy for acute cholecystitis were enrolled (Bell Land General Hospital Ethic Board approval number 2017-0003). Bile was collected from 121 patients. The Gram stain results from bile smear and culture preparations of were evaluated. Furthermore, the antimicrobial resistance was evaluated according to bile Gram stain results. Results: Bile bacteria were detected in 82 patients (67.8%) with the culture preparation and in 72 patients (59.5%) with the smear preparation. The average rate of correspondence in the Gram stain results between smear and culture preparations was 86.3% among patients with bile bacteria in the smear preparation. Cefepime and meropenem had a low antimicrobial resistance rate for all Gram stain results (< 10%). However, the resistance rate of other antimicrobial agents differed according to the Gram stain results. Conclusions: The Gram stain results from the smear preparation appear to be useful in choosing optimal perioperative antimicrobial agents.

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