The Value of Chemoprophylaxis Against Enterococcus Species in Elective Cholecystectomy: A Randomized Study of Cefuroxime vs Ampicillin-Sulbactam | Gastrointestinal Surgery | JAMA Surgery | JAMA Network
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1.
Catarci  MMancini  SGentileschi  PCamplone  CSileri  PGrassi  GB Antibiotic prophylaxis in elective laparoscopic cholecystectomy: lack of need or lack of evidence?  Surg Endosc 2004;18638- 641PubMedGoogle ScholarCrossref
2.
Koc  MZulfikaroglu  BKece  COzalp  N A prospective randomized study of prophylactic antibiotics in elective laparoscopic cholecystectomy.  Surg Endosc 2003;171716- 1718PubMedGoogle ScholarCrossref
3.
Dobay  KJFreier  DTAlbear  P The absent role of prophylactic antibiotics in low-risk patients undergoing laparoscopic cholecystectomy.  Am Surg 1999;65226- 228PubMedGoogle Scholar
4.
Cainzos  MPotel  JPuente  JL Prospective randomized controlled study of prophylaxis with cefamandole in high risk patients undergoing operations upon the biliary tract.  Surg Gynecol Obstet 1985;16027- 32PubMedGoogle Scholar
5.
Meijer  WSSchmitz  PIJeekel  J Meta-analysis of randomized, controlled clinical trials of antibiotic prophylaxis in biliary tract surgery.  Br J Surg 1990;77283- 290PubMedGoogle ScholarCrossref
6.
Stone  HHHooper  CAKolb  LDGeheber  CEDawkins  EJ Antibiotic prophylaxis in gastric, biliary and colonic surgery.  Ann Surg 1976;184443- 452PubMedGoogle ScholarCrossref
7.
Harnoss  BMHirner  ADibbelt  HHaring  RRodloff  RLode  H Perioperative antibiotic prophylaxis in bile-duct interventions.  Chemotherapy 1987;33297- 301PubMedGoogle ScholarCrossref
8.
Kaufman  ZEngelberg  MEliashiv  AReiss  R Systemic prophylactic antibiotics in elective biliary surgery.  Arch Surg 1984;1191002- 1004PubMedGoogle ScholarCrossref
9.
Sykes  DBasu  PK Prophylactic use of cefotaxime in elective biliary surgery.  J Antimicrob Chemother 1984;14 ((suppl B)) 237- 239PubMedGoogle ScholarCrossref
10.
Lewis  RTAllan  CMGoodall  RG  et al.  A single preoperative dose of cefazolin prevents postoperative sepsis in high-risk biliary surgery.  Can J Surg 1984;2744- 47PubMedGoogle Scholar
11.
Lippert  HGastinger  J Antimicrobial prophylaxis in laparoscopic and conventional cholecystectomy.  Chemotherapy 1998;44355- 363PubMedGoogle ScholarCrossref
12.
Grant  MDJones  RCWilson  SE  et al.  Single dose cephalosporin prophylaxis in high-risk patients undergoing surgical treatment of the biliary tract.  Surg Gynecol Obstet 1992;174347- 354PubMedGoogle Scholar
13.
Wilson  SEHopkins  JAWilliams  RA A comparison of cefotaxime versus cefamandole in prophylaxis for surgical treatment of the biliary tract.  Surg Gynecol Obstet 1987;164207- 212PubMedGoogle Scholar
14.
American Society of Health-System Pharmacists, Therapeutic guidelines on antimicrobial prophylaxis in surgery.  Am J Health Syst Pharm 1999;561839- 1888PubMedGoogle Scholar
15.
Rahman  MHAnson  J Peri-operative antibacterial prophylaxis.  The Pharmaceutical Journal 2004;272743- 745http://www.pjonline.com/pdf/cpd/pj_20040612_perioperative04.pdf. Accessed August 8, 2005Google Scholar
16.
 Antimicrobial prophylaxis for surgery.  Med Lett Drugs Ther 2004;227- 32Google Scholar
17.
 AMA Drug Evaluations.  Chicago, Ill American Medical Association1995;1413- 1480
18.
Dancer  SJ The problem with cephalosporins.  J Antimicrob Chemother 2001;48463- 478PubMedGoogle ScholarCrossref
19.
Powell  LLWilson  SE The role of beta-lactam antimicrobials as single agents in treatment of intra-abdominal infection.  Surg Infect (Larchmt) 2000;157- 63PubMedGoogle ScholarCrossref
20.
Pereira  SPBain  IMKumar  DDowling  RH Bile composition in inflammatory bowel disease.  Aliment Pharmacol Ther 2003;17923- 933PubMedGoogle ScholarCrossref
21.
Klotz  HPCandinas  DPlatz  A  et al.  Preoperative risk assessment in elective general surgery.  Br J Surg 1996;831788- 1791PubMedGoogle ScholarCrossref
22.
Sidi  ALobato  EBCohen  JA The American Society of Anesthesiologists' physical status: category V revisited.  J Clin Anesth 2000;12328- 334PubMedGoogle ScholarCrossref
23.
Mangram  AJHoran  TCPearson  MLSilver  LCJarvis  WR Guideline for prevention of surgical site infection, 1999.  Infect Control Hosp Epidemiol 1999;20250- 278PubMedGoogle ScholarCrossref
24.
Edwards  GFLindsay  GTaylor  EW A bacteriological assessment of ampicillin with sulbactam as antibiotic prophylaxis in patients undergoing biliary tract operations.  J Hosp Infect 1990;16249- 255PubMedGoogle ScholarCrossref
25.
Bush  LMCalmon  JJohnson  CC Newer penicillins and beta-lactamase inhibitors.  Infect Dis Clin North Am 1995;9653- 686PubMedGoogle Scholar
26.
Brook  I Aerobic and anaerobic microbiology of biliary tract disease.  J Clin Microbiol 1989;272373- 2375PubMedGoogle Scholar
27.
Krajden  SYaman  MFuksa  M  et al.  Piperacillin versus cefazolin given perioperatively to high-risk patients who undergo open cholecystectomy: a double-blind, randomized trial.  Can J Surg 1993;36245- 250PubMedGoogle Scholar
28.
Wittmann  DHKoltowski  POleszkiewicz  JWalker  AP Infectious complications after 809 biliary tract operations and results of a prospective randomized single-blind study comparing cefoxitin versus ampicillin plus an inhibitor of beta-lactamases.  Infection 1990;1841- 47PubMedGoogle ScholarCrossref
29.
Orozco  HSifuentes-Osornio  JChan  C  et al.  Comparison of ceftibuten vs. amoxicillin/clavulanic acid as antibiotic prophylaxis in cholecystectomy and/or biliary tract surgery.  J Gastrointest Surg 2000;4606- 610PubMedGoogle ScholarCrossref
30.
Tonelli  FMazzei  TNovelli  AMazzoni  PFicari  FItalian Cooperative Group, Amoxicillin/clavulanic acid versus cefotaxime for antimicrobial prophylaxis in abdominal surgery: a randomized trial.  J Chemother 2002;14366- 372PubMedGoogle ScholarCrossref
31.
Willis  RGLawson  WCHoare  EMKingston  RDSykes  PA Are bile bacteria relevant to septic complications following biliary surgery?  Br J Surg 1984;71845- 849PubMedGoogle ScholarCrossref
32.
Sheen-Chen  SChen  WEng  H  et al.  Bacteriology and antimicrobial choice in hepatolithiasis.  Am J Infect Control 2000;28298- 301PubMedGoogle ScholarCrossref
33.
Carlin  CBKent  RB  JrLaws  HL Spilled gallstones complications of abdominal wall abscesses.  Surg Endosc 1995;9341- 343PubMedGoogle ScholarCrossref
34.
Karan  JARoslyn  JJ Cholelithiasis and cholecystectomy. Zinner  MJSchwartz  SIEllis  Heds Maingot's Abdominal Operations. Vol 210th ed. Stamford, Conn Appleton & Lange1997;1717- 1738Google Scholar
35.
Kimura  TGoto  HTakeuchi  Y  et al.  Intra-abdominal contamination after gallbladder perforation during laparoscopic cholecystectomy and its complications.  Surg Endosc 1996;10888- 891PubMedGoogle ScholarCrossref
36.
Assaff  YMatter  ISabo  E  et al.  Laparoscopic cholecystectomy for acute cholecystitis and the consequences of gallbladder perforation, bile spillage, and “loss” of stones.  Eur J Surg 1998;164425- 431PubMedGoogle ScholarCrossref
37.
Wisplinghoff  HBischoff  TTallent  SM  et al.  Nosocomial bloodstream infections in US hospitals.  Clin Infect Dis 2004;39309- 317PubMedGoogle ScholarCrossref
38.
Routsi  CPlatsouka  EPaniara  O  et al.  Enterococcal infections in a Greek intensive care unit: a 5-y study.  Scand J Infect Dis 2000;32275- 280PubMedGoogle ScholarCrossref
39.
Christidou  AGikas  AScoulica  E  et al.  Emergence of vancomycin-resistance enterococci in a tertiary hospital in Crete, Greece: a cluster of cases and prevalence study on intestinal colonisation.  Clin Microbiol Infect 2004;10999- 1005PubMedGoogle ScholarCrossref
40.
Sofianou  DPournaras  SGiosi  M  et al.  Substantially increased faecal carriage of vancomycin-resistance enterococci in a tertiary Greek hospital after a 4 year time interval.  J Antimicrob Chemother 2004;54251- 254PubMedGoogle ScholarCrossref
41.
Higgins  ALondon  JCharland  S  et al.  Prophylactic antibiotics for elective laparoscopic cholecystectomy: are they necessary?  Arch Surg 1999;134611- 613PubMedGoogle ScholarCrossref
Original Article
December 1, 2006

The Value of Chemoprophylaxis Against Enterococcus Species in Elective Cholecystectomy: A Randomized Study of Cefuroxime vs Ampicillin-Sulbactam

Author Affiliations

Author Affiliations: Second Department of Surgery, [[ldquo]]Agios Panteleimon[[rdquo]] State General Hospital, Piraeus, Greece (Drs Dervisoglou, Pinis, Galanakis, Pierakakis, Giannakakis, Liveranou, Ntasiou, Karampali, Iordanou, and Giamarellou), and Fourth Department of Internal Medicine and Infectious Diseases, University of Athens Medical School, Athens, Greece (Drs Tsiodras, Kanellakopoulou, and Giamarellou).

Arch Surg. 2006;141(12):1162-1167. doi:10.1001/archsurg.141.12.1162
Abstract

Hypothesis  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.

Design  A prospective randomized controlled trial.

Setting  A major tertiary care hospital.

Patients  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.

Intervention  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.

Main Outcome Measure  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.

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