Abstract
Objective
The goal of administering preoperative systemic prophylactic antibiotics is to have the concentration in the tissues at its optimum level at the start and throughout the surgery. The rationale for the use of antibiotics is not well accepted, possible side effects and development of microbial resistance patterns are potential risks along with the financial burden. Therefore, the present study was conducted with the aim to clinically evaluate the serum and tissue concentration of single dose prophylactic ceftriaxone during an ongoing laparoscopic cholecystectomy and to find out risk factors for postoperative surgical site infection.
Method
It was an open label prospective study in 50 consecutive patients who underwent elective laparoscopic cholecystectomy under prophylactic cover of ceftriaxone. Serum and tissue concentrations were estimated by HPLC during the ongoing surgery. Subjects were observed for any postoperative complications including SSI.
Results
Serum and tissue concentrations of ceftriaxone were significant at test value of 4 mg/L. Body mass index was significantly correlated with the tissue concentration of ceftriaxone at the time of incision. The rate of SSI was 2%. It was significantly correlated with age more than 60 years, diabetes, and infected bile.
Conclusion
A single prophylactic iv dose of 1 g ceftriaxone immediately prior to skin incision in LC is good enough for prevention of SSI in Indian patients.
Similar content being viewed by others
References
Bowler PG, Duerden BI, Armstrong DG (2001) Wound microbiology and associated approaches to wound management. Clin Microbiol Rev 14:244–269
Lamb HM, Ormrod D, Scott LJ, Figgitt DP (2002) Ceftriaxone: an update of its use in the management of community-acquired and nosocomial infections. Drugs 62:1041–1089
Dietrich ES, Bieser U, Frank U, Schwarzer G, Daschner FD (2002) Ceftriaxone versus other cephalosporins for perioperative antibiotic prophylaxis: a meta-analysis of 43 randomized controlled trials. Chemotherapy 48(1):49–56
Uludag M, Yetkin G, Citgez B (2009) The role of prophylactic antibiotics in elective laparoscopic cholecystectomy. JSLS 13:337–341
Kuthe SA, Kaman L, Verma GR, Singh R (2006) Evaluation of the role of prophylactic antibiotics in elective laparoscopic cholecystectomy: a prospective randomized trial. Trop Gastroenterol 27:54–57
Chang WT, Lee KT, Chuang SC, Wang SN, Kuo KK, Chen JS, Sheen PC (2006) The impact of prophylactic antibiotics on postoperative infection complication in elective laparoscopic cholecystectomy: a prospective randomized study. Am J Surg 191:721–725
Koc M, Zulfikaroglu B, Kece C, Ozalp N (2003) A prospective randomized study of prophylactic antibiotics in elective laparoscopic cholecystectomy. Surg Endosc 17:1716–1718
Yan RC, Shen SQ, Chen ZB, Lin FS, Riley J (2011) The role of prophylactic antibiotics in laparoscopic cholecystectomy in preventing postoperative infection: a meta-analysis. J Laparoendosc Adv Surg Tech A 21:301–306
Mahatharadol V (2001) A reevaluation of antibiotic prophylaxis in laparoscopic cholecystectomy: a randomized controlled trial. J Med Assoc Thail 84:105–108
Tocchi A, Lepre L, Costa G, Liotta G, Mazzoni G, Maggiolini F (2000) The need for antibiotic prophylaxis in elective laparoscopic cholecystectomy: a prospective randomized study. Arch Surg 135:67–70
Higgins A, London J, Charland S, Ratzer E, Clark J, Haun W, Maher DP (1999) Prophylactic antibiotics for elective laparoscopic cholecystectomy: are they necessary? Arch Surg 134:611–613
Lippert H, Gastinger J (1998) Antimicrobial prophylaxis in laparoscopic and conventional cholecystectomy. Conclusions of a large prospective multicenter quality assurance study in Germany. Chemother 44:355–363
Uchiyama K, Kawai M, Onishi H, Tani M, Kinoshita H, Ueno M, Yamaue H (2003) Preoperative antimicrobial administration for prevention of postoperative infection in patients with laparoscopic cholecystectomy. Dig Dis Sci 48:1955–1959
Shindholimath VV, Seenu V, Parshad R, Chaudhry R, Kumar A (2003) Factors influencing wound infection following laparoscopic cholecystectomy. Trop Gastroenterol 24:90–92
Dervisoglou A, Tsiodras S, Kanellakopoulou K, Pinis S, Galanakis N, Pierakakis S, Giannakakis P, Liveranou S, Ntasiou P, Karampali E, Iordanou C, Giamarellou H (2006) The value of chemoprophylaxis against Enterococcus species in elective cholecystectomy: a randomized study of cefuroxime vs. ampicillin-sulbactam. Arch Surg 141:1162–1167
Sarli L, Pietra N, Costi R, Grattarola M (1999) Gallbladder perforation during laparoscopic cholecystectomy. World J Surg 23:1186–1190
Tarchini G, Liau KH, Solomkin JS (2017) Antimicrobial stewardship in surgery: challenges and opportunities. Clin Infect Dis 64:S112–S114
Graham HE, Vasireddy A, Nehra D (2014) A national audit of antibiotic prophylaxis in elective laparoscopic cholecystectomy. Ann R Coll Surg Engl 96:377–380
Shinagawa N (1989) Comparative pharmacokinetics of ceftriaxone, cefmetazole and moxalactam during abdominal surgery. J Chemother 1:524–525
Martin C, Ragni J, Lokiec F, Guillen JC, Auge A, Pecking M, Gouin F (1992) Pharmacokinetics and tissue penetration of a single dose of ceftriaxone (1,000 milligrams intravenously) for antibiotic prophylaxis in thoracic surgery. Antimicrob Agents Chemother 36:2804–2847
Liu P, Derendorf H (2003) Antimicrobial tissue concentrations. Infect Dis Clin N Am 17:599–613
Nordbring F (1978) Tissue penetration of antibiotics. Introduction. Focus on some problems involved in the treatment of infectious diseases. Scand J Infect Dis Suppl 14:21–22
Fischman AJ, Babich JW, Bonab AA, Alpert NM, Vincent J, Callahan RJ, Correia JA, Rubin RH (1998) Pharmacokinetics of [18F]trovafloxacin in healthy human subjects studied with positron emission tomography. Antimicrob Agents Chemother 42:2048–2054
Jain RK (1998) The next frontier of molecular medicine: delivery of therapeutics. Nat Med 4:655–657
Heikkinen T, Laine K, Neuvonen PJ, Ekblad U (2000) The transplacental transfer of the macrolide antibiotics erythromycin, roxithromycin and azithromycin. Br J Obstet Gynaecol 107:770–775
Overby DW, Apelgren KN, Richardson W, Fanelli R, Society of American Gastrointestinal and Endoscopic Surgeons (2010) SAGES guidelines for the clinical application of laparoscopic biliary tract surgery. Surg Endosc 24(10):2368–2386
Steinberg JP, Braun BI, Hellinger WC, Kusek L, Bozikis MR, Bush AJ, Dellinger EP, Burke JP, Simmons B, Kritchevsky SB (2009) Timing of antimicrobial prophylaxis and the risk of surgical site infections: results from the trial to reduce antimicrobial prophylaxis errors. Ann Surg 250:10–16
The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters-version 9.0. 2019. http://www.eucast.org, last accessed March 19 2020
CLSI. Performance standards for antimicrobial susceptibility testing. 28th ed. Wayne, PA: Clinical and Laboratory Standards Institute; 2018. CLSI supplement M100
Huttunen R, Karppelin M, Syrjanen J (2013) Obesity and nosocomial infections. J Hosp Infect 85:8–16
Canturk Z, Canturk NZ, Cetinarslan B, Utkan NZ, Tarkun I (2003) Nosocomial infections and obesity in surgical patients. Obes Res 11:769–775
Gao M, Sun J, Young N, Boyd D, Atkins Z, Li Z, Ding Q, Diehl J, Liu H (2016) Impact of body mass index on outcomes in cardiac surgery. J Cardiothorac Vasc Anesth 30:1308–1316
Chang WT, Lee KT, Huang MC, Chen JS, Chiang HC, Kuo KK, Chuang SC, Wang SR, Ker CG (2009) The impact of body mass index on laparoscopic cholecystectomy in Taiwan: an oriental experience. J Hepato-Biliary-Pancreat Surg 16:648–654
Yildiz B, Abbasoglu O, Tirnaksiz B, Hamaloglu E, Ozdemir A, Sayek I (2009) Determinants of postoperative infection after laparoscopic cholecystectomy. Hepatogastroenterology 56(91–92):589–592
Procter LD, Davenport DL, Bernard AC, Zwischenberger JB (2010) General surgical operative duration is associated with increased risk-adjusted infectious complication rates and length of hospital stay. J Am Coll Surg 210:60–65
Darzi AA, Nikmanesh A, Bagherian F (2016) The effect of prophylactic antibiotics on post laparoscopic cholecystectomy infectious complications: a double-blinded clinical trial. Electron Physician 8:2308–2314
Garey CL, Laituri CA, Keckler SJ, Ostlie DJ, Stagg HW, Little DC, St. Peter SD (2010) Laparoscopic cholecystectomy in obese and non-obese children. J Surg Res 163:299–302
Llor C, Bjerrum L (2014) Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Ther Adv Drug Saf 5:229–241
Author information
Authors and Affiliations
Contributions
All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Corresponding author
Ethics declarations
Competing interests
Authors state no conflict of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Sheikh, S., Malik, N.K. & Karim, B.A. Antibiotic prophylaxis and surgical site infections; a prospective open label study to clinically evaluate the serum and tissue concentration of single dose prophylactic ceftriaxone in laparoscopic cholecystectomy. Eur J Clin Pharmacol (2020). https://doi.org/10.1007/s00228-020-02940-x
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s00228-020-02940-x