Is Antibiotic Therapy Necessary after Emergency Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis?

Abstract

Background: While preoperative antibiotic therapy is standard to prevent surgical site infections in acute calculous cholecystitis, prescribing antibiotics after discharge is controversial. This study aimed to investigate the effect of antibiotic administration in discharge prescription on surgical site infections.
 Methods: Data from patients who underwent emergency laparoscopic cholecystectomy for acute calculous cholecystitis between January 2018 and February 2020 were retrospectively reviewed. Those with a decompensated systemic disease, those who were converted to open cholecystectomy, those with stage 3 disease, and those who underwent open cholecystectomy and cholecystostomy were excluded. Ampicillin-sulbactam 1 g was administered parenterally three times a day before and after surgery.
 The patients were divided into two groups according to their discharge prescriptions: those who were given antibiotics (AB group) and those who were not given antibiotics (NA group). The primary outcome was the development of surgical site infections.
 Results: 107 patients in the AB group and 109 in the NA group. Surgical site infection developed in 29 (13.4%) patients, 11 (10.3%) in the AB group, and 18 (16.5%) in the NA group. No significant difference was found between the two groups regarding surgical site infection rate (p>0.05). In logistic regression analysis, obesity was a risk factor for surgical site infections.
 Conclusions: Failure to prescribe ampicillin-sulbactam to acute calculous cholecystitis patients discharged after laparoscopic surgery does not increase surgical site infections. However, prescribing ampicillin-sulbactam to obese patients may reduce surgical site infections.
 Keywords: Surgical site infections, acute calculous cholecystitis, emergency laparoscopic cholecystectomy, obesity