Cefuroxime as a prophylactic antibiotic in laproscopic cholecystectomy

Surgical site infection (SSI) is the third most common cause of post operative morbidity and death at large1 .In the case of laparoscopic cholecystectomy(LC), the incidence of SSI is almost 3-4%.2 Although laparoscopic surgery uses smaller incision and trocars3, the chances of infections arise from the damages to the instrument made during disinfecting. Secondly, spillage of bile may cause infection even with all the aseptic techniques.4

Gallstone disease accounts for the most common biliary tract disease throughout the world figuring to almost 12% of the population in United States and 18.5% in the Europe5. Majority of patients harboring gallstones though asymptomatic still carry a risk of developing complications (1-2%)2. Laparoscopic cholecystectomy (LC), regarded the gold standard, being a very common modality of treatment is undergoing rapid improvement with the advent of newer technologies.6

At present, there are six meta-analyses that include a total of 20 randomized controlled trials which evaluate the role of prophylactic antibiotics in LC. These show no significant difference between prophylactic and non prophylactic groups7,

LC, though less invasive, is still heralded by a variety of complications of which gall bladder  (GB) perforation with free leakage of bile and stones into the peritoneal cavity is becoming increasingly common which occurs during grasping, dissection off the liver bed/during extration5,6. The advantages of laparoscopic surgery, including smaller incisions, shorter hospitalizations, less postoperative pain, and earlier return to normal activity, are attractive and promising7.

Laparoscopic cholecystectomy (LC) has a low rate of postoperative infections probably owing to smaller wounds and minimal tissue damage compared with the open procedure8. Due to its low infection rate and because the use of prophylactic antibiotics does not further decrease the rate of wound infections or other postoperative infections, many investigators believe that antimicrobial prophylaxis may be unnecessary for LC patients9. However, prophylactic antibiotic use in LC remains popular, and many surgeons believe that it decreases the incidence of postoperative infections10,11,12  .

A study conducted by Chong JU, et al; clearly states that antibiotics are not necessary for elective LC13 .In this study, percentages in two groups (with and without prophylactic antibiotics) were 1.79% and 1.56%, respectively (p=0.973).In a study by Jay Narayan Shah and his colleagues on the routine use of antibiotic prophylaxis in low risk laproscopic cholecystectomy,the overall wound infection occurred in 4.8%14. In another study Naqvi MA et al had reported 95.5% efficacy prophylactic antibiotics in LC as the frequency of post operative surgical site infection was 4.5% in prophylactic antibiotics group.15  In another study, 11.1% of the patients developed SSI after LC with single dose of cefuroxime 2gm IV given at the time of induction of anesthesia16.

REFERENCES:

1.      Bodanic B, Bosnjak Z, Budimir A, Auustin G, Milosevic M, Plecko V et al. Surveillance of surgical site infection after cholecystectomy using the hospital in Europe link for infection control through surveillance protocol. Surg Infect (Larchmt). 2013 Jun;14(3):283-7

  1. Biscione FM1, 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 Sep;28(9):1103-6.
  2. National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004 Dec;32(8):470-85.
  3. 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;11:367–70.
  4. Agrawal CS, Sehgal R, Singh RK, Gupta AK. Antibiotic prophylaxis in elective cholecystectomy: a randomized, double blinded study comparing Ciprofloxacin and cefuroxime. Indian J Physiol Pharmacol. 1999;43:501–4.
  5. Jawien M, Wojkowska-Mach J, Rozanska A, Bulanda M, Heczko PB. Surgical site infection following cholecystectomy: comparison of procedures performed with and without a laparoscope. Int J Infect Contr. 2008;4:1–5.
  6. Al-Ghnaniem R, Benjamin IS, Patel AG. Meta-analysis suggests antibiotic prophylaxis is not warranted in low-risk patients undergoing laparoscopic cholecystectomy. Brit J Surg 2003;90:365–66
  7. Catarci M, Mancini S, Gentileschi P, Camplone C, Sileri P, et al. Antibiotic prophylaxis in elective laparoscopic cholecystectomy. Lack of need or lack of evidence? Surg Endosc 2004;18:638–41.
  8. Choudhary A, Bechtold ML, Puli SR, Othman MO, Roy PK. Role of prophylactic antibiotics in laparoscopic cholecystectomy: a meta-analysis. J Gastrointest Surg. 2008;12:1847–53.
  9. Zhou H, Zhang J, Wang Q, Hu Z. Meta-analysis: Antibiotic prophylaxis in elective laparoscopic cholecystectomy. Aliment Pharmacol Ther. 2009;29:1086–95.
  10. Sanabria A, Dominguez LC, Valdivieso E, Gomez G. Antibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2010;(12):CD005265.
  11. 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;21:301–6.
  12. Chong JU, Lim JH, Kim JY The role of prophylactic antibiotics on surgical site infection in elective laparoscopic cholecystectomy. Korean J Hepatobiliary Pancreat Surg.2015;19:188–93.
  13. Shah NJ, Maharjan SB, Paudyal Routine use of antibiotic prophylaxis in low-risk laparoscopic cholecystectomy is unnecessary: a randomized clinical trial. Asia J Surg. 2012;35(4):136–39
  14. Naqvi MA, Mehraj A, Ejaz R, Mian A. Role of prophylactic antibiotics in low risk elective laparoscopic cholecystectomy: is there a need? J Ayub Med Coll Abbottabad 2013;25(1-2).
  15. Chaudhary R, Sharma S, Chaudhary S, Thakur S, Shukla A, Sharma M. A Prospective Study comparing single with multiple antibiotic prophylaxis dose in elective cholecystectomy. Ann of Int Med And Den. Res. 2015;1(1):29-33

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