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Antibiotic prophylaxis in acute cholecystectomy revisited: results of a double-blind randomised controlled trial
Gona Jaafar1, Gabriel Sandblom2, Lars Lundell3,4
1Subject Trauma Reparative Medicine, CLINTEC, Karolinska University Hospital, 14186, Stockholm, Sweden.
Insights
Preoperative antibiotic prophylaxis (PAP) does not reduce postoperative infectious complications in acute cholecystitis surgery. Further research is needed to identify key risk factors for these complications, including bacteriobilia.
Area of Science:
- Surgical Infectious Diseases
- Gastrointestinal Surgery
- Pharmacology
Background:
- Limited evidence exists on the efficacy of preoperative antibiotic prophylaxis (PAP) for acute cholecystitis.
- Acute cholecystitis management often involves surgical intervention, with infection being a potential complication.
Purpose of the Study:
- To evaluate if PAP reduces the rate of postoperative infectious complications (PIC) in patients undergoing acute cholecystectomy for cholecystitis.
- To assess secondary outcomes including bacteriobilia, C-reactive protein (CRP) levels, and leucocyte counts.
Main Methods:
- A single-centre, double-blinded, placebo-controlled, randomized study was conducted.
- Patients with acute cholecystitis underwent laparoscopic cholecystectomy and were randomized to receive either piperacillin/tazobactam (PAP) or a placebo.
Main Results:
- Of 90 patients analyzed, 22 developed PIC, with no significant difference between the PAP (8 patients) and placebo (14 patients) groups (p = 0.193).
- Higher PIC rates were observed in patients with elevated CRP levels at randomization and surgery, and in cases requiring conversion to open surgery (p < 0.05).
Conclusions:
- PAP does not appear to influence the risk of PIC in acute cholecystitis patients.
- Identifying major risk factors for PIC, such as bacteriobilia, is crucial for improving patient outcomes.
Purpose:
Evidence supporting the value of preoperative antibiotic prophylaxis (PAP) in surgery for acute cholecystitis is lacking. This study aimed to shed light on whether PAP in acute cholecystectomy for cholecystitis reduces the postoperative infectious complication (PIC) rate. Secondary outcomes were the prevalence of bacteriobilia, CRP values and leucocyte counts.
Methods:
The study was performed as a single-centre, double-blinded, placebo-controlled, randomised study. Patients with acute cholecystitis amenable for acute laparoscopic cholecystectomy were randomly assigned to either PAP (piperacillin/ tazobactam) or placebo, and the subsequent clinical course was followed.
Results:
A total of 106 patients were enrolled, 16 of whom were excluded due to protocol violation. PIC developed in 22 of the 90 patients included with no significant difference between the PAP and placebo groups (8 patients in the PAP group and 14 in the placebo arm, p = 0.193). The PIC rate was significantly higher in patients with a raised CRP at randomisation and on the day of surgery and in cases of conversion to an open procedure (p = 0.008, 0.004 and 0.017, respectively) but with no differences between the study groups.
Conclusion:
PAP does not affect the risk for PIC in patients with acute cholecystitis. The major risk factors determining PIC in these patients need defining, in particular, the impact of bacteriobilia.
Trial Registration:
The study was registered at clinicaltrials.gov (NCT02619149) December 2, 2015.
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