Surgical Antimicrobial Prophylaxis in Low-Risk Cholecystectomies is Associated with Fewer Surgical Site Infections: Nationwide Cohort Study in Switzerland

Lena Florinett; Andreas Widmer; Nicolas Troillet; Guido Beldi; Markus Von Flüe; Stephan Harbarth; Rami Sommerstein; Swissnoso

doi:10.1097/SLA.0000000000006396

Surgical Antimicrobial Prophylaxis in Low-Risk Cholecystectomies is Associated with Fewer Surgical Site Infections: Nationwide Cohort Study in Switzerland

Ann Surg. 2024 Jun 17. doi: 10.1097/SLA.0000000000006396. Online ahead of print.

Authors

Lena Florinett¹, Andreas Widmer^{2

3}, Nicolas Troillet^{3

4}, Guido Beldi⁵, Markus Von Flüe⁶, Stephan Harbarth^{3

7}, Rami Sommerstein^{1

3}; Swissnoso

Collaborators

Swissnoso:
Laurence Senn, Hugo Sax, Carlo Balmelli, Niccolò Buetti, Delphine Berthod, Philipp Jent, Jonas Marschall, Matthias Schlegel, Alexander Schweiger, Sarah Tschudin-Sutter, Danielle Vuichard Gysin, Aline Wolfensberger, Walter Zingg

Affiliations

¹ Faculty of Health Sciences and Medicine, University of Lucerne - Lucerne (Switzerland).
² Department of Infectious Diseases, University Hospital Basel - Basel (Switzerland).
³ Swissnoso, the National Center of Infection Control - Bern (Switzerland).
⁴ Service of Infectious Diseases, Central Institute, Hôpital Du Valais - Sion (Switzerland).
⁵ Department for Visceral Surgery and Medicine, Bern University Hospital - Bern (Switzerland).
⁶ Department of Visceral Surgery, Hirsalnden Clinic St. Anna, Lucerne - Lucerne (Switzerland).
⁷ Infection Control Program, Geneva University Hospitals and Faculty of medicine, WHO Collaborating Center - Geneva (Switzerland).

PMID: 38881461
DOI: 10.1097/SLA.0000000000006396

Abstract

Objective: To assess whether administration of surgical antimicrobial prophylaxis (SAP) versus absence of SAP is associated with a decreased risk of surgical site infections (SSI) after low-risk cholecystectomies (LR-CCE).

Summary background data: Current guidelines do not recommend routine SAP administration prior to LR-CCE.

Methods: This cohort study included adult patients who underwent LR-CCE and were documented by the Swissnoso SSI surveillance system between 1/2009-12/2020 at 66 Swiss hospitals. LR-CCE was specified as elective endoscopic surgery, age <70, no active cholecystitis, ASA score <3, operating time <120 minutes without implantation of foreign material. Exposure was defined as the administration of cefuroxime or cefazoline ± metronidazole within 120 minutes prior to incision versus no SAP administration. Our main outcome was occurrence of SSI until day 30. Logistic regression models were used to adjust for institutional, patient, and perioperative variables.

Results: Of 44 682 surveilled adult cholecystectomy patients, 12 521 (8 726 women [69.7%]; median [IQR] age, 49.0 [38.1-58.2] years), fulfilled inclusion criteria. SSI was identified in 143 patients (1.1%). SAP was administered in 9 269 patients (74.0%) and was associated with a lower SSI rate (adjusted odds ratio [aOR], 0.50; 95% CI, 0.35-0.70; P < 0.001). The number needed to treat to prevent one SSI episode is 100.

Conclusions: The overall LR-CCE SSI rate was 1.1%. SAP was associated with a 50% lower overall SSI rate. Patients undergoing LR-CCE may benefit from routine surgical antimicrobial prophylaxis.