Prophylactic use of cefotaxime in biliary surgery. Comparison of single-dose versus multiple-dose schedule.

Abstract

The incidence of wound infection after elective biliary surgery is reported to vary from 2.5 to 12% in the most recent reports (Keighley 1977; Scher & Scott-Conner 1987). A recent survey by Wilson et al. (1982) showed that nearly 80% of general surgeons did not routinely use antibiotic prophylaxis for elective cholecystectomy, 66% considered the incidence of wound infections too low to deserve prophylaxis and 21% expressed concern for the possible emergence of resistant organisms. Short term antibiotic prophylaxis in biliary surgery is commonly restricted to patients with high risk factors such as advanced age, obesity, jaundice, recent cholangitis, acute cholecystitis and emergency (Crenshaw et al. 1981; Di Piro et al. 1986). The use of short term prophylaxis in low risk biliary surgery remains controversial. Chetlin and Elliot (1971) reported an incidence of postoperative infections of 46% in patients with bacteria isolated in bile versus 1.2% in patients with sterile bile. In fact 25 to 35% of patients undergoing biliary tract surgery are reported to harbour bacteria in the bile. Wound infections are more frequent when bacteria are present in bile, and the bacteria cultured from bile at surgery correlate with those subsequently causing postoperative septic complications (Oelikaris et al. 1977; Keighley 1981; Keighley et al. 1977; Wolloch et al. 1977). Since the presence of bacteria in bile cannot be predicted before surgery, it has been suggestedthat short term antibiotic prophylaxis be extended to low risk biliary surgery. This paper reports the results of a prospective, single-blind, controlled and randomised trial of antibiotic prophylaxis in low risk biliary surgery, comparing the effect of single-dose versus multiple-dose cefotaxime on wound infection incidence. Cefotaxime was chosen because of its broad spectrum of activity, stability to destruction by {1-lactamases and effectiveness against most organisms commonly found in bile (Carmine et al. 1983).