Prophylactic antibiotics for elective laparoscopic cholecystectomy: are they necessary?
OBJECTIVE
Prophylactic antibiotic treatment in elective laparoscopic cholecystectomy does not lower the already low infection rate associated with this procedure.


METHODS
Prospective double-blind randomized trial at a community-based training hospital.


METHODS
Four hundred fifty patients undergoing elective laparoscopic cholecystectomy were randomized into 1 of 3 treatment arms: (1) preoperative cefotetan disodium, 1g intravenously; (2) preoperative cefazolin, 1g intravenously; and (3) intravenous placebo. There were no demographic differences between groups in age, smoking history, American Society of Anesthesiologists score, infection risk class, time of antibiotic administration prior to surgery, and type of skin preparation.


METHODS
Laparoscopic cholecystectomy was attempted in all cases; however, 10 patients required conversion to an open cholecystectomy and they were included in the statistical analysis. Preoperatively, all patients were randomized in a blinded manner and received cefotetan, cefazolin, or placebo intravenously.


RESULTS
There were 10 postoperative infections. In the cefotetan group, there were 3 cases of superficial surgical site infections. In the cefazolin group, there were 2 superficial surgical site infections-1 pneumonia and 1 rhinosinusitis. In the placebo group, there were 2 superficial surgical site infections and 1 urinary tract infection. The overall infection rate in this series was 2.4%. Follow-up was performed at routine postoperative visits and by telephone contact. Data were evaluated using the chi2 test and analysis of variance with Duncan post hoc test (P<.05).


CONCLUSIONS
Based on our data, use of prophylactic antibiotics does not decrease the rate of wound infections in elective laparoscopic cholecystectomy.
Higgins
A
A
Exempla Saint Joseph Hospital, Denver, Colo, USA.
London
J
J
Charland
S
S
Ratzer
E
E
Clark
J
J
Haun
W
W
Maher
D P
DP
D019072:Antibiotic Prophylaxis; D002437:Cefazolin / Q000627:therapeutic use*; D015313:Cefotetan / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use*; D002513:Cephamycins / Q000627:therapeutic use*; D017081:Cholecystectomy, Laparoscopic; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies
D002511:Cephalosporins; D002513:Cephamycins; D015313:Cefotetan; D002437:Cefazolin