Davide La Regina1, Matteo Di Giuseppe1, Stefano Cafarotti1, Andrea Saporito2, Marcello Ceppi3, Francesco Mongelli4, Florian Bihl5, Ruben Carlo Balzarotti Canger6, Antonjacopo Ferrario di Tor Vajana1. 1. Department of Surgery, San Giovanni Hospital, via Ospedale, Bellinzona, Switzerland. 2. Department of Anaesthesiology, San Giovanni Hospital, Bellinzona, Switzerland. 3. Unit of Clinical Epidemiology, IRCCS - Ospedale Policlinico San Martino, Genova, Italy. 4. Department of Surgery, San Giovanni Hospital, via Ospedale, Bellinzona, Switzerland. francesco.mongelli@mail.com. 5. Department of Hepatology, San Giovanni Hospital, Bellinzona, Switzerland. 6. Department of Surgery, Ospedale Civico, Lugano, Switzerland.
Abstract
INTRODUCTION: Acute cholecystitis is a common disease and a frequent cause of emergency admission to surgical wards. Evidence regarding antibiotic administration in urgent procedures is limited and remains a contentious issue. According to the Tokyo guidelines, the antibiotic administration should be guided by the severity of cholecystitis, but internationally accepted guidelines are lacking. In particular, the need to perform antibiotic therapy after laparoscopic cholecystectomy is controversial for mild and moderate acute calculous cholecystitis (Tokio I and II). MATERIALS AND METHODS: We performed a comprehensive computer literature search of PubMed and MEDLINE databases in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. We selected patients treated with cholecystectomy for mild or moderate acute calculous cholecystitis (Tokio I or II), only randomized controlled trials, (post-operative antibiotic administration versus placebo or untreated), data about local or systemic infection rate in the next 30 days after surgery. RESULTS: Three hundred and fifty-nine articles were identified, and three articles were considered eligible for the meta-analysis, including 676 patients. Overall surgical site infections were documented in 18 (5.49%) of 328 patients treated with post-operative antibiotics versus 25 (7.18%) of 348 patients treated without post-operative antibiotics. Overall results and the subgroup analysis (superficial and deep incisional infection and organ/space infection) showed no statistically significant reduction of surgical site infections rate under antibiotic therapy. CONCLUSIONS: Our meta-analysis shows no significant benefit of extended antibiotic therapy in reducing SSI after cholecystectomy for mild and moderate acute cholecystitis (Tokio I and II). Further RCTs with adequate statistical power and involving a higher number of patients with subgroups are needed to better evaluate the benefit of post-operative antibiotic treatment in reducing the rate of organ/space surgical site infections.
INTRODUCTION:Acute cholecystitis is a common disease and a frequent cause of emergency admission to surgical wards. Evidence regarding antibiotic administration in urgent procedures is limited and remains a contentious issue. According to the Tokyo guidelines, the antibiotic administration should be guided by the severity of cholecystitis, but internationally accepted guidelines are lacking. In particular, the need to perform antibiotic therapy after laparoscopic cholecystectomy is controversial for mild and moderate acute calculous cholecystitis (Tokio I and II). MATERIALS AND METHODS: We performed a comprehensive computer literature search of PubMed and MEDLINE databases in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. We selected patients treated with cholecystectomy for mild or moderate acute calculous cholecystitis (Tokio I or II), only randomized controlled trials, (post-operative antibiotic administration versus placebo or untreated), data about local or systemic infection rate in the next 30 days after surgery. RESULTS: Three hundred and fifty-nine articles were identified, and three articles were considered eligible for the meta-analysis, including 676 patients. Overall surgical site infections were documented in 18 (5.49%) of 328 patients treated with post-operative antibiotics versus 25 (7.18%) of 348 patients treated without post-operative antibiotics. Overall results and the subgroup analysis (superficial and deep incisional infection and organ/space infection) showed no statistically significant reduction of surgical site infections rate under antibiotic therapy. CONCLUSIONS: Our meta-analysis shows no significant benefit of extended antibiotic therapy in reducing SSI after cholecystectomy for mild and moderate acute cholecystitis (Tokio I and II). Further RCTs with adequate statistical power and involving a higher number of patients with subgroups are needed to better evaluate the benefit of post-operative antibiotic treatment in reducing the rate of organ/space surgical site infections.
Authors: Dale W Bratzler; E Patchen Dellinger; Keith M Olsen; Trish M Perl; Paul G Auwaerter; Maureen K Bolon; Douglas N Fish; Lena M Napolitano; Robert G Sawyer; Douglas Slain; James P Steinberg; Robert A Weinstein Journal: Am J Health Syst Pharm Date: 2013-02-01 Impact factor: 2.637
Authors: C S Loozen; K Kortram; V N N Kornmann; B van Ramshorst; B Vlaminckx; C A J Knibbe; J C Kelder; S C Donkervoort; G A P Nieuwenhuijzen; J E H Ponten; A A W van Geloven; P van Duijvendijk; W J W Bos; M G H Besselink; D J Gouma; H C van Santvoort; D Boerma Journal: Br J Surg Date: 2017-01 Impact factor: 6.939
Authors: Jean Marc Regimbeau; David Fuks; Karine Pautrat; Francois Mauvais; Vincent Haccart; Simon Msika; Muriel Mathonnet; Michel Scotté; Jean Christophe Paquet; Corinne Vons; Igor Sielezneff; Bertrand Millat; Laurence Chiche; Hervé Dupont; Pierre Duhaut; Cyril Cossé; Momar Diouf; Marc Pocard Journal: JAMA Date: 2014-07 Impact factor: 56.272