NEW YORK (Reuters Health) - In patients with common bile duct (CBD) stones undergoing same-admission cholecystectomy, surgical site infection rates are low and similar with broad- and narrow-spectrum antibiotics, observational data suggest.
Patients who received broad-spectrum (BS) antibiotics had longer hospital stays and a higher risk of acute kidney injury (AKI), however.
Dr. Brett M. Tracy of The Ohio State University Wexner Medical Center in Columbus and colleagues in the EAST Common Bile Duct Stones Study Group prospectively collected data on 891 patients over age 17 undergoing cholecystectomy at 12 centers.
Diagnosis of acute biliary pancreatitis was made by an elevated serum amylase three times greater than normal with or without radiographic evidence of pancreatitis. Choledocholithiasis diagnosis was made by an elevated serum bilirubin with or with or without an ultrasound demonstrating a dilated CBD or stone in the CBD. A concomitant diagnosis of cholecystitis was also noted.
As reported in the Journal of the American College of Surgeons, 51.7% of the patients received BS antibiotics, most commonly piperacillin/tazobactam (59.4%) and fluoroquinolones (23.4%). The remaining patients received narrow-spectrum (NS) antibiotics, most often first-generation (59.8%) or second-generation (36.7%) cephalosporins.
The median antibiotic duration was significantly longer in the BS group compared to the NS group preoperatively (3 vs 2 days; p<0.001), postoperatively (2 vs 1 days; p=0.01), and overall (6 vs 4 days, p=0.01).
