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      Can post-operative antibiotic prophylaxis following elective laparoscopic cholecystectomy be completely done away with in the Indian setting? A prospective randomised study

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          Abstract

          Premise and Objective:

          Elective laparoscopic cholecystectomy (LC) has low risk for post-operative infectious complications; still most clinicians use persistent post-operative prophylactic antibiotics out of habit, tradition, or simply as defensive practice due to evolving medicolegal implications of a large number of surgeries being showcased as daycare or next day discharge procedures. This randomised prospective trial was done to test the need for such prophylaxis in cases of elective LC in a rural/semi-urban setting.

          Materials and Methods:

          Two hundred and ten successive patients undergoing elective LC were randomised into groups receiving single dose of injection ceftriaxone at the time of induction of anaesthesia, (Group A = 112 cases) and those who in addition to above received injection ceftriaxone twice daily for 2 days postoperatively (Group B = 98 cases). Post-operative infectious complications between two groups were compared for variables such as age, sex, body mass index and bile/stone spillage.

          Results:

          There was no significant difference in surgical site infection rates between the groups for variables such as age, sex, body mass index, duration of symptoms, American Society of Anesthesiologists grade, duration of surgery and hospital stay. Intraoperative spillage of stones (9.8% [A]: 5.1% [B]) did not increase infectious complications even in the presence of positive bile culture (Group A, N = 7 vs. Group B, N = 3). An operative time of greater than 60 min was found to be associated with increased surgical site infection ( P = 0. 0006).

          Conclusion:

          Single dose of ceftriaxone at the time of induction is adequate prophylaxis following elective LC even in the rural/semi-urban Indian setting and routine continued administration of antibiotic should be abandoned as it contributes to adverse reactions, drug resistance and unnecessary financial burden.

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          Most cited references28

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          The microbiome revolution.

          The collection of bacteria, viruses, and fungi that live in and on the human body, collectively known as the microbiome, has recently emerged as an important factor in human physiology and disease. The gut in particular is a biological niche that is home to a diverse array of microbes that influence nearly all aspects of human biology through their interactions with their host; new technologies are beginning to reveal important aspects of host-microbe interactions. Articles in this Review series address how perturbations of the microbiota, such as through antibiotic use, influence its overall structure and function; how our microbiome influences the impact of infectious agents, such as C. difficile; how our microbiome mediates metabolism of xenobiotics; how the microbiota contribute to immunity as well as to metabolic and inflammatory diseases; and the role of commensal microbes in oncogenesis.
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            General surgical operative duration is associated with increased risk-adjusted infectious complication rates and length of hospital stay.

            Studies of specific procedures have shown increases in infectious complications with operative duration. We hypothesized that operative duration is independently associated with increased risk-adjusted infectious complication (IC) rates in a broad range of general surgical procedures. We queried the American College of Surgeons National Surgical Quality Improvement Program database for general surgical operations performed from 2005 to 2007. ICs (wound infection, sepsis, urinary tract infection, and/or pneumonia) and length of hospital stay (LOS) were evaluated versus operative duration (OD, ie, incision to closure). Multivariable regression adjusted for 38 patient risk variables, operation type and complexity, wound class and intraoperative transfusion. We also analyzed isolated laparoscopic cholecystectomies in patients of American Society of Anesthesiologists class 1 or 2, without intraoperative transfusion and with a clean or clean-contaminated wound class. In 299,359 operations performed at 173 hospitals, unadjusted IC rates increased linearly with OD at a rate of close to 2.5% per half hour (chi-square test for linear trend, p < 0.001). After adjustment, IC risk increased for each half hour of OD relative to cases lasting
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              The impact of prophylactic antibiotics on postoperative infection complication in elective laparoscopic cholecystectomy: a prospective randomized study.

              The aim of this prospective randomized study was to investigate the necessity and impact of prophylactic antibiotics on postoperative infection complications in elective laparoscopic cholecystectomy. At the time of induction of anesthesia, group A patients (n = 141) received 1 g cefazolin, and group B patients (control; n = 136) received 10 mL isotonic sodium chloride solution. Patients' characteristics and general operative outcomes were compared and analyzed. The overall rate of infection was 1.1% for total 277 patients (0.7% for group A patients and 1.5% for group B patients). No significant difference in infection complications was found between these 2 groups. Also any risk factors contributing to infection complications could not be found. We do not recommend the use of prophylactic antibiotics in elective laparoscopic cholecystectomy because they will not decrease the already-low rate of postoperative infectious complications.
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                Author and article information

                Journal
                J Minim Access Surg
                J Minim Access Surg
                JMAS
                Journal of Minimal Access Surgery
                Medknow Publications & Media Pvt Ltd (India )
                0972-9941
                1998-3921
                Jul-Sep 2018
                : 14
                : 3
                : 192-196
                Affiliations
                [1]Department of Surgery, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
                Author notes
                Address for correspondence: Dr. Vikram Singh Chauhan, Department of Surgery, School of Medical Sciences and Research, Sharda University, Plot No. 32-34, Knowledge Park III, Greater Noida - 201 306, Uttar Pradesh, India. E-mail: drbikramc@ 123456yahoo.co.in
                Article
                JMAS-14-192
                10.4103/jmas.JMAS_95_17
                6001298
                29067946
                a78c553f-d015-413c-a044-0b87163c9843
                Copyright: © 2018 Journal of Minimal Access Surgery

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 23 May 2017
                : 05 August 2017
                Categories
                Original Article

                Surgery
                bile culture,ceftriaxone,laparoscopic cholecystectomy,surgical site infections
                Surgery
                bile culture, ceftriaxone, laparoscopic cholecystectomy, surgical site infections

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