Randomized clinical trial of extended <i>versus</i> single-dose perioperative antibiotic prophylaxis for acute calculous cholecystitis

Loozen, C.S.; Kortram, Kirsten; Kornmann, Verena N.N.; Ramshorst, Bert van; Vlaminckx, Bart J. M.; Knibbe, Catherijne; Kelder, Johannes C.; Donkervoort, Sandra; Nieuwenhuijzen, Grard A. P.; Ponten, Jeroen E. H.; Geloven, A. A. W. van; Duijvendijk, Peter van; Bos, Willem Jan W.; Besselink, Marc G.; Gouma, Dirk J.; Santvoort, Hjalmar C. van; Boerma, Djamila

doi:10.1002/bjs.10406

Cited by 38 publications

(34 citation statements)

References 24 publications

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“…Full texts of 63 articles were reviewed and assessed for eligibility, and 34 studies including 28 RCTs and 3 prospective and 3 retrospective trials were included in this meta-analysis. Twenty-nine full-text articles555657585960616263646566676869707172737475767778798081828384 were excluded because of the following reasons: inclusion criteria not met,83 inappropriate intervention,5557707784 inappropriate comparator,565859 insufficient data reported, 606163656667686971727374757678808182 and data duplication 6264. The procedure for the study selection is summarized in the PRISMA flow diagram (Fig.…”

Section: Resultsmentioning

confidence: 99%

Role of prophylactic antibiotics in elective laparoscopic cholecystectomy: A systematic review and meta-analysis

Kim

Yang

et al. 2018

Ann Hepatobiliary Pancreat Surg

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Backgrounds/AimsThe role of prophylactic antibiotics for laparoscopic cholecystectomy in low-risk patients is still unclear. This study aimed to verify the conclusion of previous meta-analyses concerning the effectiveness of antibiotic prophylaxis for elective laparoscopic cholecystectomy in low-risk patients.MethodsComprehensive literature searches were performed on electric databases and manual searches. Randomized controlled trials (RCTs), prospective studies, and retrospective studies comparing antibiotic prophylaxis to placebo or no antibiotics in low-risk elective laparoscopic cholecystectomy were included.ResultsThis study included 28 RCTs, three prospective studies, and three retrospective studies. In RCTs, prophylactic antibiotics did not prevent deep surgical site infections (SSI) (RR 1.10, 95% confidence interval [CI] [0.45–2.69], p=0.84) but reduced SSI (RR 0.70, 95% CI [0.53–0.94], p=0.02), and superficial SSI (RR 0.58, 95% CI [0.42–0.82], p=0.01). Prospective studies showed prophylactic antibiotics did not reduce superficial SSI (RR 0.35, 95% CI [0.01–8.40], p=0.52) but reduced SSI (RR 0.12, 95% CI [0.04–0.35], p=0.0001). In retrospective studies, antibiotic prophylaxis did not reduce SSI (RR 1.59, 95% CI [0.30–8.32], p=0.58). The pooled data (12121 patients) including RCTs and prospective and retrospective studies showed that prophylactic antibiotics were not effective in preventing deep SSI (RR 1.01 95% CI [0.46–2.21], p=0.98) but effective in reducing SSI (RR 0.67, 95% CI [0.51–0.88], p=0.003) and superficial SSI (RR 0.61, 95% CI [0.45–0.83], p=0.002).ConclusionsThe use of prophylactic antibiotics is effective for reducing the incidence of SSI and superficial SSI but is not effective for preventing deep SSI in low-risk patients who underwent elective laparoscopic cholecystectomy.

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Section: Resultsmentioning

confidence: 99%

Role of prophylactic antibiotics in elective laparoscopic cholecystectomy: A systematic review and meta-analysis

Kim

Yang

et al. 2018

Ann Hepatobiliary Pancreat Surg

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“…The articles that met the selection criteria were screened initially by title, then if it was difficult to judge, the abstract was also reviewed. As a result, there were four relevant articles found: three randomized controlled trials (RCTs) and one observational study .…”

Section: How Should Highly Resistant Causative Organisms Be Managed Imentioning

confidence: 99%

Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis

Gomi

Solomkin

Schlossberg

et al. 2018

J Hepato Biliary Pancreat

269

249

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Antimicrobial therapy is a mainstay of the management for patients with acute cholangitis and/or cholecystitis. The Tokyo Guidelines 2018 (TG18) provides recommendations for the appropriate use of antimicrobials for community-acquired and healthcare-associated infections. The listed agents are for empirical therapy provided before the infecting isolates are identified. Antimicrobial agents are listed by classdefinitions and TG18 severity grade I, II, and III subcategorized by clinical settings. In the era of emerging and increasing antimicrobial resistance, monitoring and updating local antibiograms is underscored. Prudent antimicrobial usage and early de-escalation or termination of antimicrobial therapy are now important parts of decision-making. What is new in TG18 is that the duration of antimicrobial therapy for both acute cholangitis and cholecystitis is systematically reviewed. Prophylactic antimicrobial usage for elective endoscopic retrograde cholangiopancreatography is no longer recommended and the section was deleted in TG18. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.

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“…It is true that non-inferiority has not been proven in the study by Loozen et al The results according to the intention-to-treat analysis showed a postoperative complication rate of 4% in both groups with a 95% CI = [À8.2%; 8.9%] (P = 0.2%). The noninferiority margin of this study was 5% [2]. However, non-inferiority has been proven in our study.…”

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confidence: 47%

“…

It is with a certain interest that we read the new Tokyo Guidelines 2018 about the therapeutic management of acute cholangitis and calculous cholecystitis, especially the article "Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis", written by Gomi et al and published in your journal [1].To answer question 4: "What is the optimal duration of antimicrobial therapy for patients with acute cholecystitis", the authors reported two randomized clinical trials, one published by Loozen et al and the other one by our own group [2,3]. Their conclusion was "Although non-inferiority was not proven in either RCT, there was no clinically significant difference."

…”

mentioning

confidence: 99%

“…To answer question 4: "What is the optimal duration of antimicrobial therapy for patients with acute cholecystitis", the authors reported two randomized clinical trials, one published by Loozen et al and the other one by our own group [2,3]. Their conclusion was "Although non-inferiority was not proven in either RCT, there was no clinically significant difference."…”

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confidence: 99%

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Re: Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis

Guerin

Régimbeau

2018

J Hepato Biliary Pancreat

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Randomized clinical trial of extended versus single-dose perioperative antibiotic prophylaxis for acute calculous cholecystitis

Cited by 38 publications

References 24 publications

Role of prophylactic antibiotics in elective laparoscopic cholecystectomy: A systematic review and meta-analysis

Role of prophylactic antibiotics in elective laparoscopic cholecystectomy: A systematic review and meta-analysis

Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis

Re: Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis

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