Piperacillin versus cefazolin given perioperatively to high-risk patients who undergo open cholecystectomy: a double-blind, randomized trial.
OBJECTIVE
To study the efficacy, microbiologic features and toxicity of prophylactic cefazolin versus prophylactic piperacillin in high-risk patients who undergo open cholecystectomy.


METHODS
Double-blind randomized trial with follow-up for 6 weeks postoperatively.


METHODS
An 850-bed community hospital, located in a major Canadian city. Patients admitted to hospital who satisfied published criteria for being at high-risk for infection after open cholecystectomy were entered into the protocol, and those who satisfied the criteria and provided consent were entered into the study. Eighty-one patients were randomly assigned by computer to receive either piperacillin or cefazolin as the prophylactic agent.


METHODS
Open cholecystectomy.


RESULTS
Provides detailed information on the organisms found in the biliary tree in patients with acute cholecystitis, assesses the in-vitro activity of cefazolin versus piperacillin against the isolated organisms, expecting that piperacillin would be much more active against isolated anaerobes and gram-negative bacteria.


RESULTS
Bactobilia was documented in 42% of patients in the cefazolin group and 29% of patients in the piperacillin group. Piperacillin was active in vitro against 94% of all isolates versus 56% for cefazolin (p < 0.005, McNemar's test). Adverse effects and toxicities in both the piperacillin and cefazolin group were low and were not serious.


CONCLUSIONS
Both piperacillin and cefazolin are safe and effective prophylactic antimicrobials for high-risk patients who undergo open cholecystectomy. However, piperacillin had a much wider spectrum of in-vitro activity against the isolated pathogens, especially Enterococcus sp., Enterobacter cloacae and the anaerobes.
Krajden
S
S
Department of Microbiology, St. Joseph's Health Centre, Toronto, Ont.
Yaman
M
M
Fuksa
M
M
Langer
J C
JC
Rowan
J
J
Burul
C J
CJ
Wooster
D L
DL
Deitel
M
M
Borowy
Z J
ZJ
Smith
L C
LC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000517:prevention & control*; D002437:Cefazolin / Q000008:administration & dosage / Q000627:therapeutic use*; D002763:Cholecystectomy; D004311:Double-Blind Method; D005260:Female; D005704:Gallbladder / Q000382:microbiology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010878:Piperacillin / Q000008:administration & dosage / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000382:microbiology / Q000517:prevention & control*; D011292:Premedication; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control
D002437:Cefazolin; D010878:Piperacillin