Effectiveness of prophylactic antibiotics in a population-based cohort of patients undergoing planned cholecystectomy.
BACKGROUND
In the absence of randomized controlled trials with sufficient power to assess the effectiveness of prophylactic antibiotics (PA), the best evidence is provided by large population-based register studies.


METHODS
The Swedish Register of Gallstone Surgery and ERCP (GallRiks) started in May 2005 and reached 75% national coverage in 2007. During 2006 and 2007, a total of 16,400 operations were registered in GallRiks. In the present study, all elective procedures performed in 2006-2007 in units performing at least 25 operations annually were included in an analysis of the risk for postoperative infectious complications


RESULTS
Altogether 10,927 procedures were performed 2006-2007. Univariate logistic regression analysis revealed a paradoxical increase in postoperative infectious complications requiring antibiotic treatment and postoperative abscess if PA were given (p < 0.05). This increase disappeared in multivariate analysis with adjustment for age, gender, presence of cholecystitis, accidental gallbladder perforation, and presence of bile duct stones.


CONCLUSIONS
No benefit from PA was seen in this study on elective cholecystectomy. Although a randomized controlled trial could possibly show a reduction in the risk for postoperative infectious complications not detected in this study, such a reduction must be weighed against the risk of promoting drug resistance by the widespread use of PA.
Lundström
Patrik
P
Department of Surgery, Mora Hospital, Mora Lasarett, 79285 Mora, Sweden. Patrik.Lundstrom@ltdalarna.se
Sandblom
Gabriel
G
Osterberg
Johanna
J
Svennblad
Bodil
B
Persson
Gunnar
G
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D002763:Cholecystectomy / Q000009:adverse effects*; D017558:Elective Surgical Procedures; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D012042:Registries; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents