Assessing antibiotic effectiveness for reducing postoperative infectious complications in acute cholecystitis: a multicenter randomized controlled trial.

IF 12.5 2区 医学 Q1 SURGERY
Sung Eun Park, Tae Yoon Lee, Chang Ho Seo, Eui Soo Han, Tae Ho Hong
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引用次数: 0

Abstract

Background: Patients with acute cholecystitis (AC) often receive antibiotics to reduce the risk of infectious complications after cholecystectomy. This study investigated the clinical significance of antibiotic use in patients with mild-to-moderate AC who required emergency laparoscopic cholecystectomy.

Methods: This multicenter, double-blind, randomized controlled trial was conducted at four centers between February 2023 and January 2024. Patients with AC eligible for emergency laparoscopic cholecystectomy were randomly assigned to the antibiotic or placebo group. The antibiotic group received 1 g of intravenous cefazolin daily for three days during hospitalization and oral antibiotics for 4 days after discharge, whereas the placebo group received 10 mL of intravenous normal saline during their hospital stay. The primary endpoint was the rate of infectious complications.

Results: An imputed per-protocol analysis of 370 patients (185 in each group) found comparable postoperative infection rates between the antibiotic group (7.6%, 14 patients) and placebo group (7%, 13 patients), showing no statistically significant difference ( P = 0.842). Overall, the non-infectious complication rates did not differ significantly between the two groups: 21 (11.5%) cases in the antibiotic group vs. 30 (16.2%) cases in the placebo group ( P = 0.591). Considering a non-inferiority margin of 10%, the absence of antibiotic treatment did not result in worse clinical outcomes than the antibiotic treatment.

Conclusions: Administering antibiotics, even in sufficient doses, did not significantly reduce the risk of infectious complications in patients with AC compared to the group that did not receive antibiotics.

评估抗生素减少急性胆囊炎术后感染并发症的有效性:一项多中心随机对照试验。
背景:急性胆囊炎(AC)患者常接受抗生素治疗以降低胆囊切除术后感染并发症的风险。本研究探讨了轻中度AC患者需要急诊腹腔镜胆囊切除术时抗生素使用的临床意义。方法:该多中心、双盲、随机对照试验于2023年2月至2024年1月在4个中心进行。符合急诊腹腔镜胆囊切除术条件的AC患者被随机分配到抗生素组或安慰剂组。抗生素组在住院期间每天静脉注射头孢唑林1 g,连续3天,出院后口服抗生素4天,而安慰剂组在住院期间静脉注射生理盐水10 mL。主要终点是感染并发症的发生率。结果:对370例患者(每组185例)进行计算后的方案分析发现,抗生素组(7.6%,14例)和安慰剂组(7%,13例)的术后感染率相当,差异无统计学意义(P = 0.842)。总体而言,两组之间的非感染性并发症发生率无显著差异:抗生素组21例(11.5%),安慰剂组30例(16.2%)(P = 0.591)。考虑到10%的非劣效性裕度,没有抗生素治疗并不会导致比抗生素治疗更差的临床结果。结论:与未接受抗生素治疗的患者相比,给予抗生素治疗,即使剂量足够,也不能显著降低AC患者感染并发症的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
17.70
自引率
3.30%
发文量
0
审稿时长
6-12 weeks
期刊介绍: The International Journal of Surgery (IJS) has a broad scope, encompassing all surgical specialties. Its primary objective is to facilitate the exchange of crucial ideas and lines of thought between and across these specialties.By doing so, the journal aims to counter the growing trend of increasing sub-specialization, which can result in "tunnel-vision" and the isolation of significant surgical advancements within specific specialties.
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