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Pagani MA, Dolfini PM, Trazzi BFDM, Dolfini MIM, da Silva WS, Chagas EFB, Reis CHB, Pilon JPG, Pagani BT, Strasser RT, Mendes CG, Vernaschi FT, Buchaim DV, Buchaim RL. Incidence of Bacteriobilia and the Correlation with Antibioticoprophylaxis in Low-Risk Patients Submitted to Elective Videolaparoscopic Cholecystectomy: A Randomized Clinical Trial. Antibiotics (Basel) 2023; 12:1480. [PMID: 37887181 PMCID: PMC10604456 DOI: 10.3390/antibiotics12101480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/30/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
Cholelithiasis has a major impact on global health and affects an average of 20% of the Western population. The main risk factors are females, age over 40 years, obesity and pregnancy. Most of the time it is asymptomatic, but when there are symptoms, they are generally nonspecific. Bile was considered sterile, but today it is known that it contains a complex bacterial flora, which causes biofilm in the gallbladder and gallstones. Among the main bacteria associated with cholelithiasis are Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, species of Enterococcus spp. and Acinetobacter spp. Antibiotic prophylaxis is used in an attempt to reduce postoperative infections, especially at the surgical site. However, some authors found no relationship between the use of antibiotic prophylaxis and a lower risk of surgical site infection. Thus, the aim of this double-blind randomized clinical trial was to compare the existence or not of bacteriobilia in patients at low anesthetic risk who underwent videolaparoscopic cholecystectomy, and its correlation with the use of prophylactic antibiotics. This study included 40 patients between 18 and 65 years old, diagnosed with cholelithiasis, symptomatic or not, with low anesthetic risk classified by the American Society of Anesthesiology in ASA I or ASA II, without complications or previous manipulation of the bile duct, who underwent elective video cholecystectomy, divided into two groups: Experimental Group A (n = 20), which received 2 g of Cephalotin (first-generation Cephalosporin, Keflin®, ABL antibiotics, Cosmópolis, Brazil) during anesthetic induction, and Control Group B (n = 20), where no antibiotics were administered until bile collection. After the procedure, a bile sample was collected and culture and antibiogram were performed. In the sample, 22 (55%) were classified as ASA I and 18 (45%) as ASA II. It was observed that 81.8% of the patients who had a positive culture did not use antibiotics, against 18.2% of those who used prophylaxis. When comparing patients regarding anesthetic risk, ASA I patients had a positive culture in 9.1% of cases, against 90.9% in patients classified as ASA II. It was concluded that patients with higher anesthetic risk (ASA II) have a higher chance of bacteriobilia and benefit from antibiotic prophylaxis when compared to patients with lower anesthetic risk (ASA I).
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Affiliation(s)
- Marcos Alberto Pagani
- UNIMAR Beneficent Hospital (HBU), Medical School, University of Marilia (UNIMAR), Marilia 17525-160, Brazil
| | - Pedro Meira Dolfini
- Department of General Surgery, Regional Hospital, University of West Paulista (UNOESTE), Presidente Prudente 19050-680, Brazil
| | | | - Maria Ines Meira Dolfini
- Morphofunctional Department, University of West Paulista (UNOESTE), Presidente Prudente 19050-920, Brazil
| | | | - Eduardo Federighi Baisi Chagas
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR), Marilia 17525-902, Brazil
- Interdisciplinary Center on Diabetes (CENID), University of Marilia (UNIMAR), Marilia 17525-902, Brazil
| | | | - João Paulo Galletti Pilon
- UNIMAR Beneficent Hospital (HBU), Medical School, University of Marilia (UNIMAR), Marilia 17525-160, Brazil
- Postgraduate Program in Speech Therapy, Sao Paulo State University (UNESP—Universidade Estadual Paulista), Marilia 17525-900, Brazil
| | | | - Rodrigo Tavore Strasser
- Department of General Surgery, Regional Hospital, University of West Paulista (UNOESTE), Presidente Prudente 19050-680, Brazil
| | | | - Fausto Tucunduva Vernaschi
- UNIMAR Beneficent Hospital (HBU), Medical School, University of Marilia (UNIMAR), Marilia 17525-160, Brazil
- Medical School, Educational Foundation of the Municipality of Assis (FEMA), Assis 19807-130, Brazil
| | - Daniela Vieira Buchaim
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR), Marilia 17525-902, Brazil
- Medical School, University Center of Adamantina (UNIFAI), Adamantina 17800-000, Brazil
- Graduate Program in Anatomy of Domestic and Wild Animals, Faculty of Veterinary Medicine and Animal Science, University of Sao Paulo, Sao Paulo 05508-270, Brazil
| | - Rogerio Leone Buchaim
- Graduate Program in Anatomy of Domestic and Wild Animals, Faculty of Veterinary Medicine and Animal Science, University of Sao Paulo, Sao Paulo 05508-270, Brazil
- Department of Biological Sciences, Bauru School of Dentistry (FOB/USP), University of Sao Paulo, Bauru 17012-901, Brazil
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Mahmudiono T, Laksono AD. Disparity in the Hospitals Utilization among Regions in Indonesia. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract: The utilization of hospital services is a benchmark for the success of a health care referral system. Indonesia as the largest archipelago in the world encounters challenging conditions along with lack of infrastructure posed economic and health disparity among its regions. Disparities as a result of this development also have an impact on the accessibility of health care facilities. Regions with good economic movements tend to have good accessibility to health care facilities. For this reason, reducing disparity to achieve universal health services is the goal of health planners and policy makers. Chi Square test was used to test dichotomy variables and t-tests was performed for analysing the difference among continuous variables. These tests were employed to assess the hypothesis that there was significant regional difference in the access of health care in Indonesia. Estimation using multinomial logistic regression test was used to study the disparity between regions in hospital utilization. The results of this study showed that disparities between regions in Indonesia exist in term of hospital utilization. The disparities in hospital utilization among regions in Indonesia were associated with: marital status, socioeconomic status, education level, occupation and insurance ownership. However, the difference in odds ratio for mortality between regions decreased compared to the previous period. Conclusion. Disparities in the hospital utilization among region in Indonesia was associated with complex factors from individual characteristics through geographic barriers.
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Jaafar G, Sandblom G, Lundell L, Hammarqvist F. Antibiotic prophylaxis in acute cholecystectomy revisited: results of a double-blind randomised controlled trial. Langenbecks Arch Surg 2020; 405:1201-1207. [PMID: 32860109 PMCID: PMC7686002 DOI: 10.1007/s00423-020-01977-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/23/2020] [Indexed: 12/24/2022]
Abstract
Purpose Evidence supporting the value of preoperative antibiotic prophylaxis (PAP) in surgery for acute cholecystitis is lacking. This study aimed to shed light on whether PAP in acute cholecystectomy for cholecystitis reduces the postoperative infectious complication (PIC) rate. Secondary outcomes were the prevalence of bacteriobilia, CRP values and leucocyte counts. Methods The study was performed as a single-centre, double-blinded, placebo-controlled, randomised study. Patients with acute cholecystitis amenable for acute laparoscopic cholecystectomy were randomly assigned to either PAP (piperacillin/ tazobactam) or placebo, and the subsequent clinical course was followed. Results A total of 106 patients were enrolled, 16 of whom were excluded due to protocol violation. PIC developed in 22 of the 90 patients included with no significant difference between the PAP and placebo groups (8 patients in the PAP group and 14 in the placebo arm, p = 0.193). The PIC rate was significantly higher in patients with a raised CRP at randomisation and on the day of surgery and in cases of conversion to an open procedure (p = 0.008, 0.004 and 0.017, respectively) but with no differences between the study groups. Conclusion PAP does not affect the risk for PIC in patients with acute cholecystitis. The major risk factors determining PIC in these patients need defining, in particular, the impact of bacteriobilia. Trial registration The study was registered at clinicaltrials.gov (NCT02619149) December 2, 2015.
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Affiliation(s)
- Gona Jaafar
- Subject Trauma Reparative Medicine, CLINTEC, Karolinska University Hospital, 14186, Stockholm, Sweden
| | - Gabriel Sandblom
- Department of Clinical Science and Education, Department of Surgery, Södersjukhuset, Karolinska Institute, Stockholm, Sweden.
| | - Lars Lundell
- Department of Surgery, CLINTEC, Karolinska Institute, Stockholm, Sweden.,Department of Surgery, Odense University Hospital, J.B. Winsloews Vej 4, 5000, Odense, Denmark
| | - Folke Hammarqvist
- Subject Trauma Reparative Medicine, CLINTEC, Karolinska University Hospital, 14186, Stockholm, Sweden
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