Korean J Hepatobiliary Pancreat Surg.  2015 Nov;19(4):188-193. 10.14701/kjhbps.2015.19.4.188.

The role of prophylactic antibiotics on surgical site infection in elective laparoscopic cholecystectomy

• Chong JU
• Lim JH
• Kim JY
• Kim SH
• Kim KS

• KMID: 2130972
• DOI: http://doi.org/10.14701/kjhbps.2015.19.4.188

Abstract

BACKGROUNDS/AIMS
Although laparoscopic cholecystectomy is a common and widely accepted technique, the use of prophylactic antibiotics in elective laparoscopic cholecystectomy still remains controversial. The aim of this study is to determine whether prophylactic antibiotics could prevent surgical site infection after elective laparoscopic cholecystectomy and to identify any risk factors for surgical site infection.
METHODS
This study included 471 patients undergoing laparoscopic cholecystectomy between January 2009 and May 2012. Period 1 patients (279) received second generation cephalosporin 1 g intravenously after induction of anesthesia, and Period 2 patients (192) were not given prophylactic antibiotics. The characteristics and surgical site infections of the patients were compared and analyzed.
RESULTS
The overall rate of surgical site infection was 1.69% for the total of 471 patients. The incidence of surgical site infection was similar for the two Periods: 5 of 279 patients (1.79%) in Period 1, 3 of 192 patients (1.56%) in Period 2 (p=0.973). All of the patients with surgical site infections were well treated under conservative treatments without any sequelae. The preoperative albumin level (p=0.023) contributed to surgical site infection.
CONCLUSIONS
Prophylactic antibiotics are not necessary for elective laparoscopic cholecystectomy but patients in poor nutritional state with low albumin level should consider prophylactic antibiotics.

Keyword

Laparoscopic cholecystectomy; Antibiotic prophylaxis; Surgical wound infection; Nutrition assessment

MeSH Terms

Anesthesia
Anti-Bacterial Agents*
Antibiotic Prophylaxis
Cholecystectomy, Laparoscopic*
Humans
Incidence
Nutrition Assessment
Risk Factors
Surgical Wound Infection
Anti-Bacterial Agents

Reference

1. McMahon AJ, Fischbacher CM, Frame SH, MacLeod MC. Impact of laparoscopic cholecystectomy: a population-based study. Lancet. 2000; 356:1632–1637. PMID: 11089821.

2. Shea JA, Berlin JA, Bachwich DR, Staroscik RN, Malet PF, McGuckin M, et al. Indications for and outcomes of cholecystectomy: a comparison of the pre and postlaparoscopic eras. Ann Surg. 1998; 227:343–350. PMID: 9527056.

3. Choudhary A, Bechtold ML, Puli SR, Othman MO, Roy PK. Role of prophylactic antibiotics in laparoscopic cholecystectomy: a meta-analysis. J Gastrointest Surg. 2008; 12:1847–1853. PMID: 18780131.

4. Harling R, Moorjani N, Perry C, MacGowan AP, Thompson MH. A prospective, randomised trial of prophylactic antibiotics versus bag extraction in the prophylaxis of wound infection in laparoscopic cholecystectomy. Ann R Coll Surg Engl. 2000; 82:408–410. PMID: 11103159.

5. 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.

6. 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.

7. Al-Ghnaniem R, Benjamin IS, Patel AG. Meta-analysis suggests antibiotic prophylaxis is not warranted in low-risk patients undergoing laparoscopic cholecystectomy. Br J Surg. 2003; 90:365–366. PMID: 12594674.

8. Catarci M, Mancini S, Gentileschi P, Camplone C, Sileri P, Grassi GB. Antibiotic prophylaxis in elective laparoscopic cholecystectomy. Lack of need or lack of evidence. Surg Endosc. 2004; 18:638–641. PMID: 14752639.

9. Sanabria A, Dominguez LC, Valdivieso E, Gomez G. Antibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2010; (12):CD005265. PMID: 21154360.

10. 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.

11. Zhou H, Zhang J, Wang Q, Hu Z. Meta-analysis: Antibiotic prophylaxis in elective laparoscopic cholecystectomy. Aliment Pharmacol Ther. 2009; 29:1086–1095. PMID: 19236313.

12. 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.

13. SIGN. Antibiotic prophylaxis in surgery. Scottish Intercollegiate Guidelines Network (SIGN) Guidelines 104. Edinburgh, UK: SIGN;2008.

14. Matsui Y, Satoi S, Kaibori M, Toyokawa H, Yanagimoto H, Matsui K, et al. Antibiotic prophylaxis in laparoscopic cholecystectomy: a randomized controlled trial. PLoS One. 2014; 9:e106702. PMID: 25192389.

15. CDC. Surgical site infection event. Atlanta, GA: Centers for Disease Control and Prevention;2015.

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