Surgical Site Infections after Laparoscopic Bariatric Surgery: Is Routine Antibiotic Prophylaxis Required?

Abstract

Background: It is a challenging question, especially in bariatric surgery (BS), whether antibiotic prophylaxis is necessary in all cases; considering the serious consequences of surgical site infection (SSI) on the one hand and irrational use of antibiotics on the other. The aim of this study was to determine the need/rationale for antibiotic prophylaxis in patients undergoing laparoscopic bariatric surgery, especially low-risk patients. Methods: This retrospective analysis involved 313 morbidly obese patients (body Mass Index [BMI] ‡40) who underwent laparoscopic BS at three medical centers between September 2018 and June 2019. During the trial, no inducement was given to use antibiotics, and the centers had chosen whether to use prophylaxis. The U.S. Centers for Disease Control and Prevention (CDC)-2016 criteria were used for the diagnosis of SSI. Results: Antibiotic prophylaxis was given to 181 patients, and the SSI rate in the entire series was 4.5% (14/ 313). There was no significant difference in SSI between the group who received antibiotics and that who did not (2.8% versus 6.8%, respectively; p = 0.09). Post-operative intra-abdominal complications were the main independent determinant for SSIs (p < 0.001). Antibiotic prophylaxis did not have any significant effect on the rate of SSI caused by these complications (2.2% versus 3.8%, respectively; p = 0.50). The second independent factor was the rate of SSI in patients with super-obesity (BMI ‡60), particularly incisional SSIs (p < 0.001). Antibiotic prophylaxis did not produce any significant decrease in the rate of SSI in patients with a BMI < 60 (2.8% versus 5.5%, respectively; p = 0.24). When these two independent factors were excluded, there were no patients with SSI in the no-antibiotics group, and only one in the antibiotic prophylaxis group (0.5%) (p = 1.00). Conclusions: Routine antibiotic prophylaxis should be questioned in laparoscopic BS. Prophylaxis may reduce incisional SSI in patients with a BMI of ‡60. In other cases, antibiotic prophylaxis does not provide a decrease in SSI.

Shifts in gut microbiota and their metabolites induced by bariatric surgery. Impact of factors shaping gut microbiota on bariatric surgery outcomes

“…Antibiotics is another factor that has been shown to alter gut microbiota. Perioperative antibiotic prophylaxis is been questioned to be necessary for reducing surgical site infections in patients undergoing laparoscopic bariatric surgery [111]. Indeed, Jacobson et al suggested a role for antibiotic-induced dysbiosis in weight loss after SG.…”

Preventing Surgical Site Infections in the Era of Escalating Antibiotic Resistance and Antibiotic Stewardship

“…For example, in elective laparoscopic cholecystectomy without acute inflammation, surgical antibiotic prophylaxis has demonstrated minimal or no reduction in SSIs for low-risk patients . Similarly, no benefit from routine antibiotic prophylaxis has been shown for laparoscopic sleeve gastrectomy, laparoscopic roux-en-Y gastric bypass, endoscopic polypectomy, and open or transoral thryroidectomy or parathyroidectomy . For outpatient procedures such as ophthalmologic, dermatologic, fertility, or dental procedures, antibiotic use remains common, but has been shown to be unnecessary in many cases …”