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How Long Is Antibiotic Therapy Necessary After Urgent Cholecystectomy for Acute Cholecystitis?

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Objective

The objective of the study was to analyze surgical site infection (SSI) frequency with different duration antibiotic courses to establish the minimum necessary duration.

Methods

This is an observational study of prospective surveillance of 287 consecutive patients (mean age 67.8 years) operated on for acute cholecystitis of grade II severity in the first 72 h. Postoperative antibiotics had been withdrawn before diagnosis of any infection as an inclusion criterion. Patients were classified into three groups, according to therapy duration: group 1 (0–4 days, n = 45, 15.7 %); group 2 (5–7 days, n = 75, 26.1 %); and group 3 (>7 days, n = 167, 58.2 %). A multivariable analysis of risk infection was performed.

Results

Overall SSI frequency in groups 1, 2, and 3 was 2.2, 10.7, and 9 %, respectively. Risk analysis showed an increase in both crude and adjusted relative risks of overall infection in group 2 (crude relative risk (RR): 4.80 (0.62–37.13); adjusted RR, 2.03 (0.20–20.91)) and in group 3 (crude RR, 4.04 (0.55–29.79); adjusted RR, 2.35 (0.28–20.05)) by comparison with group 1, although without statistical significance. As a result, treatment lasting 4 days or less was not associated with overall surgical site infection incidence higher than longer treatment.

Conclusion

Antibiotic treatment over 4 days after early cholecystectomy provides no advantage in decreasing surgical site infection incidence.

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Author notes

  1. Giovanni Casella

    Present address: Department of Surgical Sciences “P. Stefanini,” Policlinico Umberto I, University of Rome “Sapienza”, Rome, Italy

Authors and Affiliations

  1. Department of General Surgery, University Hospital “Marqués de Valdecilla”, University of Cantabria, Avda Valdecilla S/N, 39008, Santander, Spain

    Juan C. Rodríguez-Sanjuán, Giovanni Casella, Federico Castillo, Roberto Fernández-Santiago, María Riaño, Luis A. Herrera & Manuel Gómez-Fleitas

  2. Department of Epidemiology, University Hospital “Marqués de Valdecilla”, University of Cantabria, Avda Valdecilla S/N, 39008, Santander, Spain

    Francisco Antolín

Authors
  1. Juan C. Rodríguez-Sanjuán
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  2. Giovanni Casella
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  3. Francisco Antolín
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  4. Federico Castillo
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  5. Roberto Fernández-Santiago
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  6. María Riaño
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  7. Luis A. Herrera
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  8. Manuel Gómez-Fleitas
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Corresponding author

Correspondence to Juan C. Rodríguez-Sanjuán.

Additional information

The study was approved by the local Committee of ethics in Clinical Research.

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Rodríguez-Sanjuán, J.C., Casella, G., Antolín, F. et al. How Long Is Antibiotic Therapy Necessary After Urgent Cholecystectomy for Acute Cholecystitis?. J Gastrointest Surg 17, 1947–1952 (2013). https://doi.org/10.1007/s11605-013-2321-3

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  • DOI: https://doi.org/10.1007/s11605-013-2321-3

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