title: The value of chemoprophylaxis against Enterococcus species in elective cholecystectomy: a randomized study of cefuroxime vs ampicillin-sulbactam.
abstract: OBJECTIVE
  Cephalosporins are widely used and considered to be effective as prophylaxis in biliary surgery. Nevertheless, they lack activity against enterococci. We conducted a study to compare the efficacy of ampicillin-sulbactam vs cefuroxime in preventing surgical site infections following elective cholecystectomy.
  
  
  METHODS
  A prospective randomized controlled trial.
  
  
  METHODS
  A major tertiary care hospital.
  
  
  METHODS
  Four hundred eighteen randomized patients (of 549 total), who from July 2002 to August 2004 underwent elective open or laparoscopic cholecystectomy with prospective assessment for development of surgical site infections for 1 month postoperatively.
  
  
  METHODS
  A single intravenous dose of 1.5 g of cefuroxime (group A, n = 207) or 3 g of ampicillin-sulbactam (group B, n = 211) was administered during induction of anesthesia. Bile and gallbladder mucosal cultures were taken intraoperatively from all patients.
  
  
  METHODS
  Number of postoperative surgical site infections.
  
  
  RESULTS
  A postoperative surgical site infection was noted in 19 (4.5%) of 418 patients, 18 from group A and 1 from group B (P<.001). In the group that received cefuroxime, 15 (83.3%) of 18 surgical site infections were due to Enterococcus species. Intraoperative bactibilia as well as intraoperative gallbladder rupture were associated with surgical site infections (P<.001).
  
  
  CONCLUSIONS
  A single dose of ampicillin-sulbactam favored better compared with cefuroxime for prevention of postoperative surgical site infections due to Enterococcus species after elective cholecystectomy. Ampicillin-sulbactam may be a better agent for antimicrobial prophylaxis in high-risk patients undergoing elective cholecystectomy, especially in a setting where the incidence of enterococcal infections is higher.
authors.affiliation: Second Department of Surgery, Agios Panteleimon State General Hospital, 79-81 Mpotasi Street, 18537 Piraeus, Greece. dervisoglouath@msn.com
authors.forename: Athanasios
authors.initials: A
authors.lastname: Dervisoglou
authors.forename: Sotirios
authors.initials: S
authors.lastname: Tsiodras
authors.forename: Kyriaki
authors.initials: K
authors.lastname: Kanellakopoulou
authors.forename: Stamatios
authors.initials: S
authors.lastname: Pinis
authors.forename: Nearchos
authors.initials: N
authors.lastname: Galanakis
authors.forename: Stephanos
authors.initials: S
authors.lastname: Pierakakis
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Giannakakis
authors.forename: Stavroula
authors.initials: S
authors.lastname: Liveranou
authors.forename: Panagiota
authors.initials: P
authors.lastname: Ntasiou
authors.forename: Efstathia
authors.initials: E
authors.lastname: Karampali
authors.forename: Christos
authors.initials: C
authors.lastname: Iordanou
authors.forename: Helen
authors.initials: H
authors.lastname: Giamarellou
mesh_terms: D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002444:Cefuroxime / Q000627:therapeutic use*; D018890:Chemoprevention; D002763:Cholecystectomy / Q000009:adverse effects*; D017558:Elective Surgical Procedures; D016983:Enterococcus; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013407:Sulbactam / Q000627:therapeutic use; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; C035444:sultamicillin; D000667:Ampicillin; D002444:Cefuroxime; D013407:Sulbactam