A controlled trial of parenteral prophylactic gentamicin therapy in biliary surgery

Keighley, M. R. B.; Baddeley, R. M.; Burdon, D. W.; Edwards, J. A. C.; Quoraishi, A. H.; Oates, G. D.; Watts, GeorgeT.; Alexander-Williams, J

doi:10.1002/bjs.1800620406

Cited by 88 publications

(19 citation statements)

References 16 publications

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“…1 However, many investigators have shown that prophylactic use of antibiotics in biliary surgery can markedly reduce the incidence of such septic complications . 10,11 In our series we have found that the incidence of infected bile and microbial flora is comparable to other published data. 4,5 As well, the incidence of wound infection was more than three times higher in the positive bile culture group, and serious septic complications such as septicemia, cholangitis, renal failure, and intra-abdominal abscess formation had occurred only in the positive bile culture group.…”

Section: Discussionsupporting

confidence: 91%

Routine or Selective Antibiotic Prophylaxis in Biliary Surgery

et al. 1989

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Section: Discussionsupporting

confidence: 91%

Routine or Selective Antibiotic Prophylaxis in Biliary Surgery

et al. 1989

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“…Bacteria were identified by their cultural properties, colonial appearance, and biochemical reactions. Viable counts were not measured, though previous results from this unit have shown that over 90% of positive bile cultures contain more than 105 organisms per ml (Keighley et al, 1975). The method of bile cultures was the same in the treated groups and the controls.…”

Section: Microbiological Studymentioning

confidence: 99%

Antibiotics in biliary disease: the relative importance of antibiotic concentrations in the bile and serum.

Keighley¹,

Drysdale²,

Quoraishi³

et al. 1976

Gut

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SUMMARY A randomised controlled trial has been performed in 150 patients undergoing biliary operations to determine whether an antibiotic which is excreted almost entirely in bile (rifamide) is to be preferred to one having satisfactory serum levels only (gentamicin). Patients were allocated to one of three groups: 50 received gentamicin, 50 received rifamide, and there were 50 controls who received no antibiotic cover. In the absence of duct obstruction, rifamide achieved extremely high bile levels but low serum concentrations. However, in jaundiced patients, both the bile and the serum concentrations of rifamide were too low to be of therapeutic value. The incidence of postoperative sepsis was not reduced by rifamide compared with controls. In contrast, gentamicin achieved adequate serum concentrations in 88 % of patients. Despite poor bile levels, gentamicin was associated with a significant reduction of wound infection from 22 % to 6 % and septicaemia from 14 % to 2 % compared with controls. To reduce the septic complications of biliary operations, adequate serum levels of an effective antimicrobial are more important than an antibiotic, which is excreted almost entirely into the bile.Organisms can be isolated from the bile in approximately a third of patients having operations on the biliary tract (Edlund et al., 1958). If the bile duct contains stones and the patient is jaundiced at operation, bacteria are present in 90 % of cases (Flemma et al., 1967). After biliary operations, most of the clinical infections in the wound and in the bloodstream are associated with the presence of bacteria in the bile (Mason, 1968;Keighley et al., 1974). Therefore, it is those patients with calculous obstructive jaundice who are most likely to develop wound sepsis or septicaemia after elective operation.Prophylactic antibiotics have been shown to minimise the incidence of sepsis after biliary surgery (Bevan and Williams, 1971), and it has been suggested that an antibiotic that achieves high concentrations in the bile should be used (Acocella et al., 1968). Concentrations of antibiotic in the bile in patients having operations for biliary disease are inadequate if the biliary tract is obstructed, even if the antibiotic is normally excreted in high concentrations into the bile (Zaslow et al., 1947;Zaslow et al., 1950;Zaslow and Rosenthal, 1954;Khan and Scott, 1967;Mortimer et al., 1969; Sales et al., 1972)."Reprint requests to Mr J. Alexander-Williams.Received for publication 7 April 1976 The purpose of this study is to compare the results of prophylaxis with an antibiotic almost entirely excreted in the bile (rifamide) with one having adequate concentrations only in the serum (gentamicin). Methods CLINICAL STUDYOne hundred and fifty patients undergoing operations on the biliary tract were allocated at random to one of three groups. Fifty received gentamicin, 50 were given rifamide, and there were 50 control patients who received no antibiotic cover. Randomisation was stratified to provide equal numbers of jaundiced patie...

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“…Rates of bactibilia are not reduced by prophylactic antibiotics that achieve bile levels that exceed the minimum inhibitory concentrations of recovered bacteria.27'28 Yet, decreased rates of postoperative infection are invariably reported in patients who have received prophylaxis even when rates of bactibilia are similar in treated patients and untreated controls. 16,17,[23][24][25][26][27][28] Prophylactic antibiotics that achieve good tissue levels but subtherapeutic biliary levels are also effective in preventing postcholecystectomy wound infections. 25 When used in the immediate preoperative period, prophylactic antibiotics do not select antibiotic-resistant organisms in bile.…”

Section: Discussionmentioning

confidence: 99%

Postcholecystectomy wound infection: The impact of prophylactic antibiotics on the epidemiology of infections

1987

American Journal of Infection Control

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The clinical courses of 347 patients undergoing gallbladder surgeries were monitored to study the epidemiology of postcholecystectomy wound infection in a hospital in which high-risk patients received prophylactic antibiotics. Overall, 3.8% of patients had wound infections. Patients who had positive bile cultures taken during surgery or positive intraopertive wound cultures had higher rates of infection than patients with negative cultures. However, there was a poor correlation among the bacterial isolates that were recovered from the bile or the wound surface during surgery and from postoperative infections. Antibioticsensitive enteric bacteria were recovered from bile samples at surgery, gram-positive organisms and enteric gram-negative bacteria were isolated from intraopertive cultures of the wound surface, and antibiotic-resistant gram-negative bacteria or enterococci were recovered from wounds that developed postoperative infections. There was a strong association between the prior receipt of prophylactic antibiotics and infections with antibiotic-resistant bacteria. Data suggest that bactibilia is still an important epidemiologic marker that identifies patients at high risk for subsequent wound infection. However, in patients who have received prophylactic antibiotics, intraopertive cultures cannot be relied on to guide the choice of empiric therapeutic antibiotics for postoperative infections. Bacteria responsible for these infections are not identified by cultures taken at the time of surgery and are often resistant to the class of antibiotics used for prophylaxis. E -s XTENSIVE LITERATURE characterizes the epidemiology and risk factors for postoperative wound infections after gallbladder surgery."'3 These studies document a strong association between the presence of bacteria in bile cultures taken at surgery and the occurrence of subsequent infection. Patients with bacti-

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A controlled trial of parenteral prophylactic gentamicin therapy in biliary surgery

Cited by 88 publications

References 16 publications

Routine or Selective Antibiotic Prophylaxis in Biliary Surgery

Routine or Selective Antibiotic Prophylaxis in Biliary Surgery

Antibiotics in biliary disease: the relative importance of antibiotic concentrations in the bile and serum.

Postcholecystectomy wound infection: The impact of prophylactic antibiotics on the epidemiology of infections

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