B. M. Tracy1, K. Nahum1, C. Paterson2, B. K. Poulose1, B. R. Hochman5, R. Rattan4, D. D. Yeh4, R. B. Gelbard3 1Ohio State University, Department Of Surgery, Columbus, OH, USA 2Emory University School Of Medicine, Department Of Surgery, Atlanta, GA, USA 3University Of Alabama at Birmingham, Division Of Acute Care Surgery, Birmingham, Alabama, USA 4University Of Miami, Department Of Surgery, Miami, FL, USA 5Columbia University College Of Physicians And Surgeons, Department Of Surgery, New York, NY, USA
Introduction: Antimicrobial guidance for common bile duct (CBD) stones during the perioperative period is limited. We sought to examine the effect of extended spectrum (ES) versus narrow spectrum (NS) antibiotics on postoperative outcomes in patients with CBD stones undergoing same admission cholecystectomy.
Methods: We performed a post-hoc analysis of a prospective, observational, multicenter study of patients undergoing same admission cholecystectomy for choledocholithiasis (CDL) and/or gallstone pancreatitis (GSP) between 2016 and 2019. We excluded patient with cholangitis, bacteremia, pneumonia, and/or urinary tract infections on admission; patients with perforated cholecystitis intraoperatively were also excluded. For both the pre- and postoperative periods, patients were divided into groups based on receipt of ES or NS antibiotics. Primary outcomes included surgical site infection (SSI) and/or severe sepsis. Secondary outcomes included hospital length of stay (HLOS) and acute kidney injury (AKI).
Results: There were 891 patients in the cohort; 49.9% (n=445) patients preoperatively and 21.2% (n=189) patients postoperatively received ES antibiotics. Patients receiving NS antibiotics during the preoperative period had significantly lower white blood cell counts on admission (8.7K vs 9.9K, p<.0001). There was no difference between groups regarding rates of SSI or sepsis in both the pre- and postoperative periods. However, patients receiving ES antibiotics postoperatively (5d vs 4d, p=0.002) had a longer HLOS. Rates of AKI were significantly higher for patients who received ES antibiotics in the preoperative (4.7% vs 2.0%, p=0.03) and postoperative (5.4% vs 0%, p=0.01) periods. For patients who received ES antibiotics during both the pre- and postoperative periods, the odds of AKI (OR 2.5, 95% CI 1.1-5.3, p=0.02) was significantly greater compared to NS antibiotics.
Conclusion: The incidence of SSI and severe sepsis were similar between patients treated with ES and NS antibiotics. However, the use of ES antibiotics was associated with a significantly longer HLOS and more than twice the risk of AKI. We caution the regular use of ES antibiotics in this patient population; however, randomized trials are needed to validate our findings.