Ann Surg Treat Res.  2017 Aug;93(2):76-81. 10.4174/astr.2017.93.2.76.

Are prophylactic antibiotics necessary in elective laparoscopic cholecystectomy, regardless of patient risk?

• Kim HJ
• Kang SH
• Roh YH
• Kim MC
• Kim KW

• KMID: 2387337
• DOI: http://doi.org/10.4174/astr.2017.93.2.76

Abstract

PURPOSE
The average rate of surgical site infections (SSIs) for laparoscopic cholecystectomy (LC) has been reported in the literature to be between 0.4% and 6.3%. Also, these recent reviews have concluded that a prophylactic antibiotics for elective LCs in low-risk patients is not useful, but there were no results in high-risk patients.
METHODS
The aim of this study was to investigate the role of a single dose of first-generation cephalosporin as a prophylactic antibiotic for patients undergoing elective LC, regardless of patient risk. This randomized clinical trial was conducted from October 2013 to December 2014 by single surgeon at our hospital. Patients were randomized into two groups by following method. Odd-numbered patients (group A) received 1-g cefazolin intravenously within 30 minutes before incision, whereas even-numbered patients (group B) received normal saline intravenously instead of prophylactic antibiotics, with the aim of including 100 patients in each group. SSIs were recorded and compared between the groups.
RESULTS
There were no differences in preoperative demographics and postoperative findings between the groups. There were no superficial and deep SSIs in either group, 9 cases of superficial seromas developed (4.5%) in the cohort: 4 in group A (4%) and 5 in group B (5%). There were no significant associations between SSIs and the use of prophylactic antibiotics in either group. Additionally, the high-risk group did not show a significantly increased rate of SSIs.
CONCLUSION
Based on our study, prophylactic antibiotics are not necessary in elective LC, regardless of patient risk.

Keyword

Laparoscopic cholecystectomy; Antibiotic prophylaxis; Surgical wound infection

MeSH Terms

Anti-Bacterial Agents*
Antibiotic Prophylaxis
Cefazolin
Cholecystectomy, Laparoscopic*
Cohort Studies
Demography
Humans
Methods
Seroma
Surgical Wound Infection
Anti-Bacterial Agents
Cefazolin

Reference

1. Chang WT, Lee KT, Chuang SC, Wang SN, Kuo KK, Chen JS, et al. The impact of prophylactic antibiotics on postoperative infection complication in elective laparoscopic cholecystectomy: a prospective randomized study. Am J Surg. 2006; 191:721–725. PMID: 16720138.

2. Biscione FM, Couto RC, Pedrosa TM, Neto MC. Comparison of the risk of surgical site infection after laparoscopic cholecystectomy and open cholecystectomy. Infect Control Hosp Epidemiol. 2007; 28:1103–1106. PMID: 17932836.

3. McGuckin M, Shea JA, Schwartz JS. Infection and antimicrobial use in laparoscopic cholecystectomy. Infect Control Hosp Epidemiol. 1999; 20:624–626. PMID: 10501264.

4. Koc M, Zulfikaroglu B, Kece C, Ozalp N. A prospective randomized study of prophylactic antibiotics in elective laparoscopic cholecystectomy. Surg Endosc. 2003; 17:1716–1718. PMID: 12802644.

5. Mahatharadol V. A reevaluation of antibiotic prophylaxis in laparoscopic cholecystectomy: a randomized controlled trial. J Med Assoc Thai. 2001; 84:105–108. PMID: 11281486.

6. Yildiz B, Abbasoglu O, Tirnaksiz B, Hamaloglu E, Ozdemir A, Sayek I. Determinants of postoperative infection after laparoscopic cholecystectomy. Hepatogastroenterology. 2009; 56:589–592. PMID: 19621660.

7. Higgins A, London J, Charland S, Ratzer E, Clark J, Haun W, et al. Prophylactic antibiotics for elective laparoscopic cholecystectomy: are they necessary? Arch Surg. 1999; 134:611–613. PMID: 10367869.

8. Sharma N, Garg PK, Hadke NS, Choudhary D. Role of prophylactic antibiotics in laparoscopic cholecystectomy and risk factors for surgical site infection: a randomized controlled trial. Surg Infect (Larchmt). 2010; 11:367–370. PMID: 20575704.

9. Ruangsin S, Laohawiriyakamol S, Sunpaweravong S, Mahattanobon S. The efficacy of cefazolin in reducing surgical site infection in laparoscopic cholecystectomy: a prospective randomized double-blind controlled trial. Surg Endosc. 2015; 29:874–881. PMID: 25052130.

10. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Am J Infect Control. 1999; 27:97–132. PMID: 10196487.

11. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013; 70:195–283. PMID: 23327981.

12. Nam EY, Kim HB, Bae H, Moon S, Na SH, Kim SY, et al. Appropriateness of surgical antibiotic prophylaxis in a tertiary hospital. Korean J Nosocomial Infect Control. 2014; 19:64–70.

13. Kacelnik O, Alberg T, Mjaland O, Eriksen H, Skjeldestad FE. Guidelines for antibiotic prophylaxis of cholecystectomies in Norwegian hospitals. Surg Infect (Larchmt). 2013; 14:188–191. PMID: 23530809.

14. Kuthe SA, Kaman L, Verma GR, Singh R. Evaluation of the role of prophylactic antibiotics in elective laparoscopic cholecystectomy: a prospective randomized trial. Trop Gastroenterol. 2006; 27:54–57. PMID: 16910066.

15. Dobay KJ, Freier DT, Albear P. The absent role of prophylactic antibiotics in low-risk patients undergoing laparoscopic cholecystectomy. Am Surg. 1999; 65:226–228. PMID: 10075297.

16. Uludag M, Yetkin G, Citgez B. The role of prophylactic antibiotics in elective laparoscopic cholecystectomy. JSLS. 2009; 13:337–341. PMID: 19793473.

17. Yan RC, Shen SQ, Chen ZB, Lin FS, Riley J. The role of prophylactic antibiotics in laparoscopic cholecystectomy in preventing postoperative infection: a meta-analysis. J Laparoendosc Adv Surg Tech A. 2011; 21:301–306. PMID: 21443433.

18. Dervisoglou A, Tsiodras S, Kanellakopoulou K, Pinis S, Galanakis N, Pierakakis S, et al. The value of chemoprophylaxis against Enterococcus species in elective cholecystectomy: a randomized study of cefuroxime vs ampicillin-sulbactam. Arch Surg. 2006; 141:1162–1167. PMID: 17178957.

19. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999; 20:250–278. PMID: 10219875.