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Antibiotic prophylaxis in elective laparoscopic cholecystectomy is useless. A prospective multicenter study
Aim:
We performed a prospective study to evaluate the effect of antibiotic prophylaxis (AP) on the incidence of infection in elective laparoscopic cholecystectomy (LC).
Material Of Study:
All patients were at low-medium anesthetic and infectious risk and underwent LC for benign disease. At induction of anesthesia 41 patients received ampicillin-sulbactam 3g, 40 patients received ciprofloxacin 400mg intravenously, and 53 patients received no AP.
Results:
Postoperative infection was observed in 11 patients (8.2%) in the entire study group. All ob served infections were superficial surgical site infections (SSIs), always located at the umbilical incision. Infection occurred in 3 patients (7.3%) in ampicillin-sulbactam group, in 3 patients (7.5%) in ciprofloxacin group and in 5 patients (9.4%) in nonantibiotic group (p=0.916). Univariate analysis showed that duration of operation, placement of a drain and postoperative hospital stay were significantly associated with the development of SSIs. At multivariate analysis, only duration of operation was statistically significant in predicting SSIs.
Discussion:
The present study did not show any advantage in the use of AP, although in case of difficult surgery the risk of SSIs is increased, in particular in the umbilical incision. In all patients, the bile culture was sterile, then the infection of the umbilical site is not due to bacterial infection from the gallbladder.
Conclusions:
AP in elective LC should not be routinely performed. A particular attention to the preoperative cleaning and topical antibiotic therapy of the umbilical area is advised.
Insights
Antibiotic prophylaxis (AP) did not reduce surgical site infections (SSIs) in elective laparoscopic cholecystectomy (LC). Focus on umbilical site care is recommended, especially for longer procedures, as AP showed no benefit in preventing these infections.
Area of Science:
- Surgical Infection Prevention
- Laparoscopic Surgery Outcomes
- Antibiotic Prophylaxis Efficacy
Background:
- Superficial surgical site infections (SSIs) are a concern in elective laparoscopic cholecystectomy (LC).
- The role of antibiotic prophylaxis (AP) in preventing SSIs in LC remains under investigation.
Purpose of the Study:
- To prospectively evaluate the impact of antibiotic prophylaxis (AP) on the incidence of SSIs following elective laparoscopic cholecystectomy (LC).
Main Methods:
- A prospective study involving patients undergoing elective LC for benign conditions.
- Patients received either ampicillin-sulbactam, ciprofloxacin, or no antibiotic prophylaxis (AP).
- Infection rates, particularly superficial surgical site infections (SSIs), were monitored postoperatively.
Main Results:
- Overall infection rate was 8.2%, with all infections being superficial surgical site infections (SSIs) at the umbilical incision.
- No significant difference in SSI incidence was observed between the antibiotic prophylaxis (AP) groups and the no-AP group (7.3%, 7.5%, and 9.4%, respectively; p=0.916).
- Multivariate analysis identified duration of operation as the only significant predictor of SSIs.
Conclusions:
- Routine antibiotic prophylaxis (AP) is not recommended for elective laparoscopic cholecystectomy (LC).
- Increased risk of SSIs, particularly at the umbilical site, is associated with longer operative times.
- Enhanced preoperative cleaning and topical antibiotic therapy for the umbilical area may be beneficial.