Prophylaxis In Biliary Surgery Research Articles

The Value of Chemoprophylaxis Against Enterococcus Species in Elective Cholecystectomy

Cephalosporins are widely used and considered to be effective as prophylaxis in biliary surgery. Nevertheless, they lack activity against enterococci. We conducted a study to compare the efficacy of ampicillin-sulbactam vs cefuroxime in preventing surgical site infections following elective cholecystectomy. A prospective randomized controlled trial. A major tertiary care hospital. Four hundred eighteen randomized patients (of 549 total), who from July 2002 to August 2004 underwent elective open or laparoscopic cholecystectomy with prospective assessment for development of surgical site infections for 1 month postoperatively. A single intravenous dose of 1.5 g of cefuroxime (group A, n = 207) or 3 g of ampicillin-sulbactam (group B, n = 211) was administered during induction of anesthesia. Bile and gallbladder mucosal cultures were taken intraoperatively from all patients. Number of postoperative surgical site infections. A postoperative surgical site infection was noted in 19 (4.5%) of 418 patients, 18 from group A and 1 from group B (P<.001). In the group that received cefuroxime, 15 (83.3%) of 18 surgical site infections were due to Enterococcus species. Intraoperative bactibilia as well as intraoperative gallbladder rupture were associated with surgical site infections (P<.001). A single dose of ampicillin-sulbactam favored better compared with cefuroxime for prevention of postoperative surgical site infections due to Enterococcus species after elective cholecystectomy. Ampicillin-sulbactam may be a better agent for antimicrobial prophylaxis in high-risk patients undergoing elective cholecystectomy, especially in a setting where the incidence of enterococcal infections is higher.

Pharmacokinetics and tissue distribution of intravenous pefloxacin for antibiotic prophylaxis in biliary surgery.

The plasma levels and tissue penetration of pefloxacin were studied after prophylactic administration to patients undergoing elective biliary surgery. Pefloxacin was administered as a single dose of 800 mg given intravenously as an infusion 1 h before surgery. Over a period of two years, cultures of bile and stone were performed after cholecystectomy in order to find the main pathogens present in the geographical area of the hospital of Txagorritxu (Vitoria, Spain), as well as to test the antimicrobial susceptibility of these bacteria to pefloxacin. Thirty seven per cent of the bile and stone cultures were positive, and 75 different species were isolated. E. coli was the predominant microorganism (25%). Other frequent microorganisms were E. faecium (9.3%), S. epidermidis (6.6%) and Cl. perfringens (6.6%). Most species isolated were susceptible to pefloxacin, with MIC(90) values of 0.125 microg/ml for E. coli, 0.5 microg/ml for S. epidermidis and 1 microg/ml for Cl. perfringens. E. faecium was resistant, with a MIC(90) value of 8 microg/ml but a MIC(50) of 4 microg/ml (intermediate). After pefloxacin infusion, adequate drug plasma levels (>MIC(90)) for the most frequent pathogens were found throughout the procedure. Elimination half-life was estimated as 22.03+/-6.91 h; the area under the concentration-time curve from zero to infinite had a value of 275.07+/-130.02 mg h/l and the values for volume of distribution at steady-state and plasma clearance were 96.48+/-28.65 L and 3.60+/-1.83 l/h, respectively. Bile pefloxacin concentrations generally exceeded the minimum inhibitory concentrations for most relevant pathogens. Drug levels in gallbladder and subcutaneous tissues were also above the MIC(90) for extended periods. Patients were observed daily throughout their hospital stay. This included examination of the surgical wound and recording of body temperature. No cases of anaerobic infection were noted in the study patients. Other constants such as hospitalization stay and time of recuperation were normal for this type of surgery. According to these results, pefloxacin presents many features that make it suitable for use as a therapeutic prophylactic agent, such as its broad spectrum of antimicrobial activity and favorable pharmacokinetic properties.

Pharmacokinetics of ofloxacin enantiomers after intravenous administration for antibiotic prophylaxis in biliary surgery.

The pharmacokinetics of S-(-)- and R-(+)-ofloxacin, enantiomers of the fluoroquinolone ofloxacin, were characterized after prophylactic administration in 15 patients undergoing elective biliary surgery. A single dose of ofloxacin 400 mg given intravenously as an infusion was administered 1 hour before surgery. Plasma levels of S-(-)- and R-(+)-ofloxacin showed very small differences between both enantiomers, although the ratio of S-(-)- to R-(+)-enantiomer concentration in plasma showed significant differences (p < 0.05) at 4 and 12 hours. Adequate S-(-)-ofloxacin (levofloxacin, the active enantiomer) plasma levels (> or = minimum inhibitory concentration [MIC90] for Escherichia coli) were found throughout the procedure. For pharmacokinetic parameters, the authors found small but statistically significant differences (p < 0.05) in the area under the concentration-time curve, AUC0-infinity (22.30 +/- 2.72 mg h/L for S-(-)-ofloxacin vs. 20.50 +/- 2.06 mg h/L for R-(+)-ofloxacin), and in the clearance (0.15 +/- 0.04 L/h/Kg for S-(-)-ofloxacin vs. 0.16 +/- 0.04 L/h/Kg for R-(+)-ofloxacin). To test the penetration of ofloxacin enantiomers into tissues, the authors measured levels in subcutaneous cell tissue and gall-bladder cell tissue. They did not observe statistical differences between the two isomers, which means that distribution is not an estereoselective process. Enantiomer levels in these two tissues decreased rapidly, but the highest concentrations were reached during the 4 first hours (i.e., when the surgical procedure was being performed). In conclusion, with the prophylactic treatment used, levofloxacin plasma and tissue levels are high enough to prevent surgical infections.

Pharmacokinetics and Tissue Distribution of Intravenous Ofloxacin for Antibiotic Prophylaxis in Biliary Surgery

The plasma levels and tissue penetration of ofloxacin were studied after prophylactic administration in 17 patients undergoing elective biliary surgery. A single dose of ofloxacin 400mg given intravenously as an infusion was administered 1 hour before surgery. Adequate drug plasma levels [>/= minimum inhibitory concentration (MIC(90)) for Escherichia coli] were found throughout the procedure. Mean peak (1 hour) and last-determined (36 hours) ofloxacin serum levels were 7.97 +/- 3.79 mg/L and 0.19 +/- 0.13 mg/L, respectively. The elimination half-life (t((1/2)lambda)) was 8.86 +/- 3.07 hours, and the clearance and steady-state volume of distribution were 0.17 +/- 0.05 L/h.kg and 112.90 +/- 37.09L, respectively. The area under the plasma concentration-time curve from zero to infinity (AUC(0-infinity)) was 41.60 +/- 12.51 mg/L.h. In bile, ofloxacin levels were higher than in plasma and showed great variability. Adequate ofloxacin levels in subcutaneous cell tissue and gallbladder wall tissue were observed during the surgical procedure. Patients were observed daily throughout their hospital stay. This included examination of the surgical wound and recording of body temperature. No cases of anaerobic infection were noted in the study patients. Other constants such as hospitalisation stay and time of recuperation were normal for this type of surgery.

Antibiotic prophylaxis in biliary surgery

Early studies in which a higher incidence of wound infection and septic complications in biliary surgery was found demonstrated the need for antibiotic prophylaxis. In two studies, one retrospective and one prospective, the role of prophylactic antibiotics in biliary surgery was studied in "at risk" and "no risk" groups of patients. Twenty-eight percent of "no risk" patients had a positive bile culture. It was concluded that a single dose of 1 g cefotaxime, administered upon induction of anaesthesia, is a safe and effective prophylactic regimen in biliary surgery.

Routine or Selective Antibiotic Prophylaxis in Biliary Surgery

The microbial flora of the bile were prospectively studied in 299 patients admitted for biliary surgery. None of those patients received any antibiotic before the bile specimens were obtained. Posi...

The Pharmacokinetics of The Biliary Excretion of Ciprofloxacin

The pharmacokinetics of ciprofloxacin excretion have been studied in 54 patients undergoing biliary and pancreatic operations with and without obstruction of the common bile duct. High concentrations were achieved in common duct bile within 20 minutes of intravenous injection and persisted for over 3 hours after 100 mg and for over 8 hours after 200 mg. The concentration of ciprofloxacin in the bile of functioning gall bladders was much greater than that in the common duct bile. Remarkably, it was identified in therapeutic concentrations in the bile of obstructed ducts. This and the rapid fall from initially high venous concentrations probably reflect diffusion from the circulation as a result of the exceptional tissue penetration. A unique feature of this study was the finding of clinically significant concentrations in the bile of obstructed ducts. Two patients developed wound infection and no side effects were observed. The broad spectrum antibiotic ciprofloxacin has potential as a useful agent for prophylaxis in biliary surgery maintaining biliary and venous concentrations in excess of the MIC90 for most biliary pathogens for more than 8 hours.

Antimicrobial prophylaxis in biliary surgery.

AbstractInfection is a problem in biliary surgery and precautions should be taken to reduce this. A policy for the prophylactic use of antibiotics is essential. Patients who are at risk should be identified by assessment of clinical parameters and/or by duodenal intubation and immediate plating of the bile specimen. The antibiotic should be carefully chosen after consultation with the bacteriology department. Prospective collection of data should begin with specimens of gallbladder wall, bile, and a stone sent for both aerobic and anaerobic culture. The selected antibiotic should be started preoperatively.

Septic complications and bile cultures in 800 consecutive cholecystectomies.

AbstractBenign disease of the biliary tract has become the most common indication for major abdominal surgery. Septic complications play an increasingly important role in the morbidity and mortality of biliary tract disease and biliary surgery. This prospective study deals with 800 consecutive cholecystectomies in which bacteriology data were studied and correlated with clinical data. The general incidence of positive bile cultures was 27%. Patients with a high incidence of positive cultures (high‐risk group) included those with acute cholecystitis, jaundice, choledochal stones, diabetes mellitus, nonfunctioning gallbladders, and patients over 70. Patients not presenting any of the above features (low‐risk group) had a very low incidence of positive bile cultures (less than 7.1%). The types of bacteria cultured were gram‐negative bacteria in the great majority of cases, gentamicin showing the highest sensitivity rate (91%). Close correlation was found between positive bile cultures and the incidence of septic complications. The results of this study support the view that perioperative antibiotic prophylaxis in biliary surgery should be given only to those patients defined as high risk. In the low‐risk group, about 60% of all cases, antibiotics can be omitted safely.

The Role of Antibiotic Prophylaxis in Biliary Surgery

International Journal of Clinical PracticeVolume 35, Issue 4 p. 140-146 Clinical Studies The Role of Antibiotic Prophylaxis in Biliary Surgery W. E. G. Thomas MS, FRCS, W. E. G. Thomas MS, FRCS Department of Surgery, Frenchay Hospital, BristolSearch for more papers by this authorR. E. May MS, FRCS, R. E. May MS, FRCS Department of Surgery, Frenchay Hospital, BristolSearch for more papers by this author W. E. G. Thomas MS, FRCS, W. E. G. Thomas MS, FRCS Department of Surgery, Frenchay Hospital, BristolSearch for more papers by this authorR. E. May MS, FRCS, R. E. May MS, FRCS Department of Surgery, Frenchay Hospital, BristolSearch for more papers by this author First published: 01 April 1981 https://doi.org/10.1111/j.1742-1241.1981.tb08243.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Volume35, Issue4April 1981Pages 140-146 RelatedInformation