Meta-analysis of perioperative antibiotics in patients undergoing laparoscopic cholecystectomy.
BACKGROUND
The effectiveness of perioperative antibiotics in reducing surgical-site infection (SSI) and overall nosocomial infections in patients undergoing laparoscopic cholecystectomy for biliary colic and low- and moderate-risk cholecystitis (Tokyo classification) is unclear. A systematic review and meta-analysis was performed to assess this.


METHODS
Searches were conducted of the MEDLINE, Embase and Cochrane databases. Only randomized clinical trials (RCTs) were included. The analysis was performed using the random-effects method, and the risk ratio (RR) with 95 per cent c.i. was employed.


RESULTS
Nineteen RCTs, published between 1997 and 2015, with a total of 5259 participants, of whom 2709 (51·5 per cent) were treated with antibiotics, were included. SSI and overall nosocomial infections were detected in 2·4 and 4·2 per cent respectively of patients given perioperative antibiotics, and in 3·2 and 7·2 per cent of those who received no antibiotics. Antibiotics did not significantly reduce the risk of SSI (RR 0·81, 95 per cent c.i. 0·58 to 1·13; P = 0·21) or overall nosocomial infections (RR 0·64, 0·36 to 1·14; P = 0·13). There was no significant between-study heterogeneity for SSI, but significant between-study heterogeneity in the eight studies that reported nosocomial infections. Analysis of studies considered to be high quality, grouped according to the timing of antibiotics (preoperative only or perioperative) and reporting intention-to-treat analyses, again failed to show a significant reduction in SSI.


CONCLUSIONS
Antibiotics should not be administered before laparoscopic cholecystectomy in patients with biliary colic and/or low- and moderate-risk cholecystitis.
Department of Upper Gastro-Intestinal Surgery, Queen Elizabeth Hospital, Birmingham, UK.|Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), Queen Elizabeth Hospital, Birmingham, UK.
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http://orcid.org/0000-0003-4815-6293
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Pasquali
Department of Upper Gastro-Intestinal Surgery, Queen Elizabeth Hospital, Birmingham, UK.
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Boal
Department of Upper Gastro-Intestinal Surgery, Queen Elizabeth Hospital, Birmingham, UK.
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Griffiths
Department of Upper Gastro-Intestinal Surgery, Queen Elizabeth Hospital, Birmingham, UK.|Academic Department of Surgery, University of Birmingham, Birmingham, UK.
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Alderson
Department of Upper Gastro-Intestinal Surgery, Queen Elizabeth Hospital, Birmingham, UK.|Academic Department of Surgery, University of Birmingham, Birmingham, UK.
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Vohra
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000601:surgery*; D003428:Cross Infection / Q000517:prevention & control*; D006801:Humans; D015233:Models, Statistical; D013530:Surgical Wound Infection / Q000517:prevention & control*
D000900:Anti-Bacterial Agents