Antibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy

Sanábria, Álvaro; Domínguez, Luis Carlos; Valdivieso, Eduardo; Gómez, Gabriel

doi:10.1002/14651858.cd005265.pub2

Cited by 52 publications

(39 citation statements)

References 48 publications

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“…Some clinical trials suggest that antibiotic prophylaxis may not be necessary in LC, especially in patients with uncomplicated gallstones who underwent elective LC (9,10). Either way, the better knowledge about the nature of bacteria in bile and their antimicrobial susceptibility patterns could play an important role in the proper selection of antibiotics for prophylaxis, especially in high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

“…Obtaining bile culture during biliary surgery is mainly advised only in patients with some predisposing factors that could increase the risk of such infections. These risk factors include pyrexia, previous biliary instrumentation, previous biliary sepsis, bilioenteric anastomosis, immune suppression status, a palpable gallbladder, elevated WBC count, and elevated serum levels of alkaline phosphatase and old age (2,5,8,10,11). However, reports are still conflicting over the use of bile culture at biliary surgery (6,12).…”

Section: Introductionmentioning

confidence: 99%

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Bactobilia Among Patients with Uncomplicated Cholelithiasis Undergoing Laparoscopic Cholecystectomy: The Risk Factors and Effects on Postoperative Infectious Complications

Ghahramani¹,

Jahromi²,

Pouladfar³

et al. 2017

Ann Colorectal Res

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Background: Determining the rate of bactibilia among patients under going laparoscopic cholecystectomy (LC) and its correlations with predisposing factors and postoperative infections, which help evaluate the need for prophylactic antibiotic. Methods: In this prospective study, 85 consecutive patients with uncomplicated cholelithiasis who underwent LC were enrolled from 2012 to 2013. Routine bile culture was done at the time of LC. Patients were divided into 2 groups, 1 with negative bile culture and another with bactibilia. Demographic and laboratory data were compared. Patients were followed up 10 days after their laparoscopy and 1 month after discharge to monitor the presence of infection. Results: A total of 7 cultures of bile were positive for bacteria (8.2 %). The patients' age was the sole factor with a significant relationship with the rate of bactobilia (P = 0.016). Within 10 days after surgery, fever and surgical site infection were detected in 10.6% of patients, which was not significantly different in the 2 groups. There were no complications in the 30-day follow-up. Conclusions: Detecting bactobilia with low frequency and the lack of correlation between bactobilia and postoperative infectious, complications did not support prescribing prophylactic antibiotic in respective patients. The older age was the sole predisposing factor for the development of bactobilia.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bactobilia Among Patients with Uncomplicated Cholelithiasis Undergoing Laparoscopic Cholecystectomy: The Risk Factors and Effects on Postoperative Infectious Complications

Ghahramani¹,

Jahromi²,

Pouladfar³

et al. 2017

Ann Colorectal Res

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“…In general terms, antibiotic prophylaxis is restricted to patients undergoing cholecystectomy with associated risk factors. These include coexistence of choledocolithiasis and/or cholangitis, age over 70 years, duration of intervention over 70 minutes, prior biliary instrumentation, American Society of Anesthetics index (ASA) > 2 and diabetes mellitus (13)(14)(15)(16).…”

Section: Discussionmentioning

confidence: 99%

Antibiotic prophylaxis in elective cholecystectomy: Protocol adequacy and related outcomes in a retrospective single-centre analysis

et al. 2015

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Background: Antibiotic prophylaxis is an effective tool to reduce surgical infection rates. However, antibiotic prophylaxis in cholecystectomy is controversial when non-high risk patients are considered. This research aims to evaluate the adherence with antibiotic prophylaxis protocol in patients undergoing cholecystectomy, and its impact in the outcomes of surgical infection.Methods: This single-center observational and retrospective study analyzed all elective cholecystectomy procedures carried out at the Fundación Alcorcón University Hospital in the period 2007-2014. Data were recovered from hospital records; rates of adherence to the available hospital protocols were evaluated for choice, initiation, duration, administration route and dosages of antibiotics, and the starting and duration of the prophylaxis.Results: The overall adequacy rate to protocol was 72%. The adherence rates in both the administration route and dose were 100%. The most common violations of the protocol included the choice of antibiotic agent (19%), followed by the moment of initiating its administration (8.9%). The overall wound infection rate was lower in case of laparoscopy than in laparotomy cholecystectomy (1.4% vs. Conclusions: The overall adequacy rate to antibiotic prophylaxis protocol recommended for elective cholecystectomy in our hospital was high (72%). No significant association between the adequacy or antibiotic prophylaxis and surgical infection was found.

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“…In patients undergoing laparoscopic cholecystectomy, a previous study showed that preoperative ERCP and age were predictors of bactobilia (7). It has been suggested that prophylactic antibiotics should be limited to patients with risk factors of bactobilia (13), but there is not sufficient evidence to support or refute the use of antibiotic prophylaxis in patients undergoing elective laparoscopic cholecystectomy with low risk of complications (14). Since bactobilia status at the time of surgery, and especially in the presence of resistant bacteria, is unknown, identification of predictors of bactobilia by resistant bacteria is important.…”

Section: Discussionmentioning

confidence: 99%

“…Identification of risk factors for bactobilia and bile cultures during biliary surgery are useful for planning antibiotic prophylaxis and treatment measures (6,9,13). However, a recent systematic review of the Cochrane database showed that there is not sufficient evidence to support or refute the use of antibiotic prophylaxis to reduce surgical site infection and global infections in patients undergoing elective laparoscopic cholecystectomy with low risk of anesthetic complications, comorbidities, conversion to open surgery, and infectious complications (14).…”

mentioning

confidence: 99%

Prevalence of and Risk Factors for Biliary Carriage of Bacteria Showing Worrisome and Unexpected Resistance Traits

et al. 2013

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Antibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy

Cited by 52 publications

References 48 publications

Bactobilia Among Patients with Uncomplicated Cholelithiasis Undergoing Laparoscopic Cholecystectomy: The Risk Factors and Effects on Postoperative Infectious Complications

Bactobilia Among Patients with Uncomplicated Cholelithiasis Undergoing Laparoscopic Cholecystectomy: The Risk Factors and Effects on Postoperative Infectious Complications

Antibiotic prophylaxis in elective cholecystectomy: Protocol adequacy and related outcomes in a retrospective single-centre analysis

Prevalence of and Risk Factors for Biliary Carriage of Bacteria Showing Worrisome and Unexpected Resistance Traits

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