Piperacillin versus cefazolin given perioperatively to high-risk patients who undergo open cholecystectomy: a double-blind, randomized trial.

Abstract

OBJECTIVE:

To study the efficacy, microbiologic features and toxicity of prophylactic cefazolin versus prophylactic piperacillin in high-risk patients who undergo open cholecystectomy.

DESIGN:

Double-blind randomized trial with follow-up for 6 weeks postoperatively.

SETTING:

An 850-bed community hospital, located in a major Canadian city. Patients admitted to hospital who satisfied published criteria for being at high-risk for infection after open cholecystectomy were entered into the protocol, and those who satisfied the criteria and provided consent were entered into the study. Eighty-one patients were randomly assigned by computer to receive either piperacillin or cefazolin as the prophylactic agent.

INTERVENTIONS:

Open cholecystectomy.

MAIN OUTCOME:

Provides detailed information on the organisms found in the biliary tree in patients with acute cholecystitis, assesses the in-vitro activity of cefazolin versus piperacillin against the isolated organisms, expecting that piperacillin would be much more active against isolated anaerobes and gram-negative bacteria.

RESULTS:

Bactobilia was documented in 42% of patients in the cefazolin group and 29% of patients in the piperacillin group. Piperacillin was active in vitro against 94% of all isolates versus 56% for cefazolin (p < 0.005, McNemar's test). Adverse effects and toxicities in both the piperacillin and cefazolin group were low and were not serious.

CONCLUSIONS:

Both piperacillin and cefazolin are safe and effective prophylactic antimicrobials for high-risk patients who undergo open cholecystectomy. However, piperacillin had a much wider spectrum of in-vitro activity against the isolated pathogens, especially Enterococcus sp., Enterobacter cloacae and the anaerobes.

• Authors: S Krajden, M Yaman, M Fuksa, J C Langer, J Rowan, C J Burul, D L Wooster, M Deitel, Z J Borowy, L C Smith
• Journal: Canadian journal of surgery. Journal canadien de chirurgie (Can J Surg) Vol. 36 Issue 3 Pg. 245-50 (Jun 1993) ISSN: 0008-428X [Print] Canada
• PMID: 8324671 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Cefazolin
• Piperacillin

Topics

• Adult
• Aged
• Aged, 80 and over
• Bacteria (isolation & purification)
• Bacterial Infections (prevention & control)
• Cefazolin (administration & dosage, therapeutic use)
• Cholecystectomy
• Double-Blind Method
• Female
• Gallbladder (microbiology)
• Humans
• Male
• Microbial Sensitivity Tests
• Middle Aged
• Piperacillin (administration & dosage, therapeutic use)
• Postoperative Complications (microbiology, prevention & control)
• Premedication
• Prospective Studies
• Risk Factors
• Surgical Wound Infection (microbiology, prevention & control)