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Antibiotic Prophylaxis in Elective Laparoscopic Cholecystectomy: a Systematic Review and Network Meta-Analysis

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Objective

To determine the effectiveness and harms of using antibiotic prophylaxis (ABP) versus placebo/no intervention in patients undergoing elective laparoscopic cholecystectomy (eLCC) to prevent surgical site infection (SSI).

Methods

We searched MEDLINE (OVID), EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to October 2017. We included clinical trials which involved adults at low risk undergoing eLCC and compared ABP versus placebo/no intervention. The primary outcome was SSI and secondary outcomes were other infections and adverse effects. Cochrane Collaboration tool was used to assess the risk of bias. We performed the statistical analysis in R and reported information about risk difference (RD) with a 95% confidence interval (CI). Heterogeneity was evaluated using the I2 test. We produced network diagrams to show the amount of evidence available for each outcome and the most frequent comparison.

Results

We included 18 studies in qualitative and quantitative analysis. The antibiotics most commonly studied were cefazolin and cefuroxime. We found high risk of detection bias in one study and attrition bias in another. Unclear risks of selection, performance, and detection bias were frequent. For SSI, we found no heterogeneity I2 = 0% and no inconsistency p = 0.9780. No significant differences were found when compared ABP versus placebo/no intervention. Cefazolin had a RD of − 0.00 (95% CI − 0.01 to 0.01). We found no differences in regular meta-analysis, with a RD of − 0.00 (95% CI − 0.01 to 0.01) as well as for intra-abdominal and distant infections. Adverse effects were only assessed in one study, without any case reported.

Conclusions

This systematic review demonstrated no differences between ABP versus placebo/no intervention when using to prevent SSI and intra-abdominal and distant infections in patients at low risk undergoing eLCC.

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Author information

Authors and Affiliations

  1. Urological Research Group (UROGIV), Universidad del Valle, Cll 4B # 36-00, Cali, Colombia

    Juan Camilo Gomez-Ospina MD, James A. Zapata-Copete MD & Herney Andrés García-Perdomo MD MSc EdD PhD FACS

  2. Medicine School, Universidad del Valle, Cali, Colombia

    Juan Camilo Gomez-Ospina MD

  3. Epidemiology Department, Universidad Libre, Cali, Colombia

    James A. Zapata-Copete MD

  4. Surgery Department, Clinica Farallones, Cali, Colombia

    Monica Bejarano MD MSc

  5. Medicine School, Universidad del Valle, Cali, Colombia

    Herney Andrés García-Perdomo MD MSc EdD PhD FACS

Authors
  1. Juan Camilo Gomez-Ospina MD
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  2. James A. Zapata-Copete MD
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Contributions

Juan Camilo Gomez-Ospina: design, analysis, and interpretation of data for the work; drafting the work; revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work.

James A. Zapata-Copete: design, analysis, and interpretation of data for the work; drafting the work; revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work.

Monica Bejarano: design, analysis, and interpretation of data for the work; drafting the work; revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work.

Herney Andrés García-Perdomo: design, analysis, and interpretation of data for the work; drafting the work; revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work.

Corresponding author

Correspondence to Juan Camilo Gomez-Ospina MD.

Ethics declarations

Ethics Statement

This systematic review and meta-analysis accomplish all the ethics requirements according to Helsinki declaration and all international statements.

Appendix

Appendix

Search Strategies

Medline (Ovid):

Exp Cholecystectomy, Laparoscopic

(Laparoscopic adj2 cholecystectomy).mp

(Elective adj2 laparoscopic cholecystectomy).mp

Exp Cholecystectomy

Or/

Exp Anti-bacterial agents

Anti-bacterial agent$.mp

Antibacterial agent$.mp

(anti*bacterial adj2 agent*).mp

Exp Antibiotic Prophylaxis

(Antibiotic adj2 prophylaxis).mp

Antibiotic$.mp

Or/

randomized controlled trial.pt

controlled clinical trial.pt

clinical trial.pt

randomized.ab

placebo.ab

randomly.ab

trial.ab

(clinical adj2 trial).mp

(randomi*ed adj2 controlled adj2 trial).mp

exp double-blind method

or/

Embase:

’laparoscopic cholecystectomy’/exp

(laparoscopic next/2 cholecystectomy):ti,ab

(elective next/2 laparoscopic cholecystectomy):ti,ab

‘cholecystectomy’/exp

or/

'antiinfective agent'/exp

Antiinfective agent*:ti,ab

Antibacterial:ti,ab

'antibiotic prophylaxis'/exp

Antibiotic prophylaxis:ti,ab

antibiotic*:ti,ab

Or/

'randomized controlled trial'/exp

(randomi*ed NEXT/2 controlled NEXT/2 trial):ti,ab

'clinical trial'/exp

(clinical NEXT/2 trial):ti,ab

‘controlled clinical trial’/exp

'double blind procedure'/exp

or/

Central (Ovid)

Exp Cholecystectomy, Laparoscopic

(Laparoscopic adj2 cholecystectomy).mp

(Elective adj2 laparoscopic cholecystectomy).mp

Exp Cholecystectomy

Or/

Exp. Anti-bacterial agents

Anti-bacterial agent$.mp

Antibacterial agent$.mp

(anti*bacterial adj2 agent*).mp

Exp. Antibiotic Prophylaxis

(Antibiotic adj2 prophylaxis).mp

Antibiotic$.mp

Or/

LILACS

(mh:"colecistectomía" OR mh:"colecistectomía Laparoscópica" OR tw:"colecistectomía Laparoscópica" OR tw:"colecistectomía") AND (mh:"antibacterianos" OR mh:"profilaxis antibiótica" tw:"profilaxis antibiótica") AND (mh:"ensayo clínico" OR tw:"doble ciego" OR tw:"experimento clínico" OR mh:"estudios de cohortes" OR mh:"Estudios de casos y controles")

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Gomez-Ospina, J.C., Zapata-Copete, J.A., Bejarano, M. et al. Antibiotic Prophylaxis in Elective Laparoscopic Cholecystectomy: a Systematic Review and Network Meta-Analysis. J Gastrointest Surg 22, 1193–1203 (2018). https://doi.org/10.1007/s11605-018-3739-4

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  • DOI: https://doi.org/10.1007/s11605-018-3739-4

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