Журнал «Медицина неотложных состояний» Том 20, №2, 2024

Лапароскопічна холецистектомія у пацієнтів із холециститом вважається кращим, доцільним і безпечним методом лікування жовчнокам’яної хвороби. Водночас роль призначення антибіотиків до або після холецистектомії для зниження інфекційних ускладнень, зокрема інфекцій місця операції, або смертності менш ясна. Багато пацієнтів отримують емпірично антибіотики, але доцільність їх використання не доведена. Деякі рекомендації пропонують використовувати антибіотикопрофілактику при всіх холецистектоміях, хоча поточні дані не вказують на будь-які переваги цієї практики за відсутності факторів ризику. У цьому огляді розглядаються результати застосування антибіотиків при лапароскопічній холецистектомії з приводу хронічного і гострого калькульозного холециститу. Більшість досліджень заперечує необхідність використовувати профілактичні антибіотики під час планової операції у пацієнтів низького ризику. У випадках гострого холециститу легкого та середнього ступеня тяжкості застосування антибіотиків для профілактики післяопераційних інфекційних ускладнень не має доказів ефективності, хоча ці рекомендації теж неоднозначні. Не рекомендується використовувати післяопераційні антибіотики після планової лапароскопічної холецистектомії, а також з приводу легкого або середньої тяжкості гострого холециститу. Проте необхідні додаткові дослідження з чітко визначеними популяціями пацієнтів і порівнянними результатами, щоб краще оцінити найбільш підходящий час і тривалість застосування антибіотиків у хворих, яким проводиться лапароскопічна холецистектомія. Для пошуку літературних джерел використовували базу даних MedLine на платформі PubMed і бібліотеку Cochrane.

Laparoscopic cholecystectomy in patients with cholecystitis is considered the best, appropriate and safe method of treatment for gallstone disease. However, the role of antibiotic administration before or after cholecystectomy to reduce infectious complications, particularly surgical site infections, or mortality is less clear. Many patients receive empiric antibiotics, but the feasibility of their use has not been proven. Some guidelines suggest the use of antibiotic prophylaxis for all cholecystectomies, although current evidence does not indicate any benefit to this practice in the absence of risk factors. This review examines the results of antibiotic use in laparoscopic cholecystectomy for chronic and acute calculous cholecystitis. Most studies argue against the need to use prophylactic antibiotics during elective surgery in low-risk patients. In cases of mild and moderate acute cholecystitis, the use of antibiotics to prevent postoperative infectious complications has no evidence of effectiveness, although these recommendations are also ambiguous. It is not recommended to use postoperative antibiotics after elective laparoscopic cholecystectomy, as well as for mild or moderate acute cholecystitis. However, additional studies with well-defined patient populations and comparable outcomes are needed to better assess the most appropriate timing and duration of antibiotic use in patients undergoing laparoscopic cholecystectomy. We used MedLine database on the PubMed platform and the Cochrane library to search for literature sources.

калькульозний холецистит; лапароскопічна холецистектомія; інфекційні ускладнення; антибіотики

calculous cholecystitis; laparoscopic cholecystectomy; infectious complications; antibiotics

1. Oliveira R.S., Silva P.D., Queiroz C.A.S., et al. Prevalence оf Bacteriobilia іn Patients Undergoing Elective Colecystectomy. Arq. Bras. Cir. Dig. 2018. 31(3). e1392. doi: 10.1590/0102-672020180001e1392.
2. Binda C., Gibiino G., Coluccio C., et al. Biliary Diseases from the Microbiome Perspective: How Microorganisms Could Change the Approach to Benign and Malignant Diseases. Microorganisms. 2022. 10(2). 312. doi: 10.3390/microorganisms10020312.
3. Tazuma S., Unno M., Igarashi Y., et al. Evidence-based clinical practice guidelines for cholelithiasis 2016. Gastroenterol. 2017. 52(3). 276-300. doi: 10.1007/s00535-016-1289-7.
4. Wang L., Mirzaie S., Dunnsiri T., et al. Systematic review and meta-analysis of the 2010 ASGE non-invasive predictors of choledocholithiasis and comparison to the 2019 ASGE predictors. Clin. J. Gastroenterol. 2022. 15(2). 286-300. doi: 10.1007/s12328-021-01575-4.
5. Peery A.F., Crockett S.D., Murphy C.C., et al. Burden and Cost of Gastrointestinal, Liver, and Pancreatic Diseases in the United States: Update 2021. Gastroenterology. 2022. 162(2). 621-644. doi: 10.1053/j.gastro.2021.10.017.
6. Politano S.A., Hamiduzzaman N., Alhaqqan D. Diseases of the Gallbladder and Biliary Tree. Prim Care. 2023. 50(3). 377-390. doi: 10.1016/j.pop.2023.03.004.
7. Coccolini F., Solaini L., Binda C., et al. Laparoscopic Cholecystectomy in Acute Cholecystitis: Refining the Best Surgical Timing Through Network Meta-Analysis of Randomized Trials. Surg. Laparosc. Endosc. Percutan Tech. 2022. 32(6). 755-763. doi: 10.1097/SLE.0000000000001103.
8. La Regina D., Di Giuseppe M., Cafarotti S., et al. Antibiotic administration after cholecystectomy for acute mild-moderate cholecystitis: a PRISMA-compliant meta-analysis. Surg. Endosc. 2019. 33(2). 377-383. doi: 10.1007/s00464-018-6498-0.
9. Enochsson L., Thulin A., Osterberg J., et al. The Swedish Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks): A nationwide registry for quality assurance of gallstone surgery. JAMA Surg. 2013. 148(5). 471-478. doi: 10.1001/jamasurg.2013.1221.
10. Cao A.M., Eslick G.D., Cox M.R. Early Cholecystectomy Is Superior to Delayed Cholecystectomy for Acute Cholecystitis: a Meta-analysis. J. Gastrointest. Surg. 2015. 19(5). 848-857. doi: 10.1007/s11605-015-2747-x.
11. Regimbeau J.M., Fuks D., Pautrat K., et al. Effect of post-operative antibiotic administration on postoperative infection following cholecystectomy for acute calculous cholecystitis: a randomized clinical trial. JAMA. 2014. 312(2). 145-154. doi: 10.1001/jama.2014.7586.
12. Smith J.P., Samra N.S., Ballard D.H., et al. Prophylactic Antibiotics for Elective Laparoscopic Cholecystectomy. Am. Surg. 2018. 84(4). 576-580. PMID: 29712609.
13. Sanabria A., Dominguez L.C., Valdivieso E., Gomez G. Antibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy. Cochrane Database Syst. Rev. 2010. (12). CD005265. doi: 10.1002/14651858.CD005265.pub2.
14. Loozen C.S., van Santvoort H.C., van Geloven A.A.W., et al. Perioperative antibiotic prophylaxis in the treatment of acute cholecystitis (PEANUTS II trial): study protocol for a randomized controlled trial. Trials. 2017. 18(1). 390. doi: 10.1186/s13063-017-2142-x.
15. Satheeskaran M., Hussan A., Anto A., de Preux L. Cost-effectiveness analysis of antibiotic prophylaxis versus no antibiotic prophylaxis for acute cholecystectomy. BMJ Open Gastroenterol. 2023. 10(1). e001162. doi: 10.1136/bmjgast-2023-001162. 
16. Davey P., Marwick C.A., Scott C.L., et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst. Rev. 2017. 2(2). CD003543. doi: 10.1002/14651858.CD003543.pub4.
17. Berríos-Torres S.I., Umscheid C.A., Bratzler D.W., et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017. 152(8). 784-791. doi: 10.1001/jamasurg.2017.0904.
18. Choudhary A., Bechtold M.L., Puli S.R., et al. Role of prophylactic antibiotics in laparoscopic cholecystectomy: a meta-analysis. J. Gastrointest. Surg. 2008. 12(11). 1847-1853; discussion 1853. doi: 10.1007/s11605-008-0681-x.
19. Seidelman J.L., Mantyh C.R., Anderson D.J. Surgical Site Infection Prevention: A Review. JAMA. 2023. 329(3). 244-252. doi: 10.1001/jama.2022.24075. 
20. Abeysuriya V., Deen K.I., Wijesuriya T., Salgado S.S. Microbiology of gallbladder bile in uncomplicated symptomatic cholelithiasis. Hepatobiliary Pancreat. Dis. Int. 2008. 7(6). 633-637. PMID: 19073410.
21. Oliveira R.S., Silva P.D., Queiroz C.A.S., et al. Prevalence оf Bacteriobilia іn Patients Undergoing Elective Colecystectomy. Arq. Bras. Cir. Dig. 2018. 31(3). e1392. doi: 10.1590/0102-672020180001e1392.
22. Grigorʼeva I.N., Romanova T.I. Gallstone Disease and Microbiome. Microorganisms. 2020. 8(6). 835. doi: 10.3390/microorganisms8060835.
23. Kim T., Park S.Y., Kwak Y.G., et al. Etiology, characteristics, and outcomes of community-onset necrotizing fasciitis in Korea: A multicenter study. PLoS One. 2019. 14(6). e0218668. doi: 10.1371/journal.pone.0218668.
24. Young Kim E., Ho Hong T. Empirical antibiotics for acute cholecystitis-what generation of antibiotics is an appropriate choice? A prospective, randomized controlled study. J. Hepatobiliary Pancreat. Sci. 2021. 28(10). 848-855. doi: 10.1002/jhbp.926.
25. Roulin D., Saadi A., Di Mare L., et al. Early Versus Delayed Cholecystectomy for Acute Cholecystitis, Are the 72 hours Still the Rule? A Randomized Trial. Ann. Surg. 2016. 264(5). 717-722. doi: 10.1097/SLA.0000000000001886.
26. Nitzan O., Brodsky Y., Edelstein H., et al. Microbiologic data in acute cholecystitis: ten years’ experience from bile cultures obtained during percutaneous cholecystostomy. Surg. Infect. 2017. 18(3). 345-349. doi: 10.1089/sur.2016.232.
27. van Dijk A.H., de Reuver P.R., Tasma T.N., et al. Systematic review of antibiotic treatment for acute calculous cholecystitis. Br. J. Surg. 2016. 103(7). 797-811. doi: 10.1002/bjs.10146.
28. Armiñanzas C., Tigera T., Ferrer D., et al. Role of bacteriobilia in postoperative complications. Rev. Esp. Quimioter. 2016. 29(3). 123-129. PMID: 27062981.
29. Gomi H., Solomkin J.S., Schlossberg D., et al. Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. J. Hepatobiliary Pancreat. Sci. 2018. 25(1). 3-16. doi: 10.1002/jhbp.518.
30. Park S.E., Choi H.J., You Y.K., Hong T.H. Clinical significance of preoperative antibiotic use in mild to moderate acute inflammatory gallbladder disease: A randomized controlled trial. J. Hepatobiliary Pancreat. Sci. 2023. 30(4). 482-492. doi: 10.1002/jhbp.1237. 
31. Hirata B.H.N., Sasagawa S., Navarini A., et al. Comparison of bacterial profile of gallbladder with gallstones from patients undergoing cholecystectomy due to complicated and uncomplica-ted cholelithiasis: changes in the epidemiological scenario. Rev. Col. Bras. Cir. 2023. 50. e20233474. doi: 10.1590/0100-6991e-20233474-en.
32. Kim Y.S. Practical Use of Antibiotics in Pancreatobiliary Diseases. Korean J. Pancreas Biliary Tract. 2014. 19(4). 157-163. doi: https://doi.org/10.15279/kpba.2014.19.4.157.
33. Galili O., Eldar S. Jr, Matter I., et al. The effect of bactibilia on the course and outcome of laparoscopic cholecystectomy. Eur. J. Clin. Microbiol. Infect. Dis. 2008. 27(9). 797-803. doi: 10.1007/s10096-008-0504-8.
34. Mazeh H., Mizrahi I., Dior U., et al. Role of antibiotic the-rapy in mild acute calculus cholecystitis: a prospective randomized controlled trial. World J. Surg. 2012. 36(8). 1750-1759. doi: 10.1007/s00268-012-1572-6.
35. Rhodes A., Evans L.E., Alhazzani W., et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017. 43(3). 304-377. doi: 10.1007/s00134-017-4683-6.
36. Suh S.W., Choi Y.S., Choi S.H., et al. Antibiotic selection based on microbiology and resistance profiles of bile from gallbladder of patients with acute cholecystitis. Sci. Rep. 2021. 11(1). 2969. doi: 10.1038/s41598-021-82603-8.
37. Hajibandeh S., Popova P., Rehman S. Extended Postoperative Antibiotics Versus No Postoperative Antibiotics in Patients Undergoing Emergency Cholecystectomy for Acute Calculous Cholecystitis: A Systematic Review and Meta-Analysis. Surg. Innov. 2019. 26(4). 485-496. doi: 10.1177/1553350619835347. 
38. Al-Ghnaniem R., Benjamin I.S., Patel A.G. Meta-analysis suggests antibiotic prophylaxis is not warranted in low-risk patients undergoing laparoscopic cholecystectomy. Br. J. Surg. 2003. 90(3). 365-366. doi: 10.1002/bjs.4033.
39. Pasquali S., Boal M., Griffiths E.A., et al. Meta-analysis of perioperative antibiotics in patients undergoing laparoscopic cholecystectomy. Br. J. Surg. 2016. 103(1). 27-34; discussion 34. doi: 10.1002/bjs.9904.
40. Gomez-Ospina J.C., Zapata-Copete J.A., et al. Antibiotic Prophylaxis in Elective Laparoscopic Cholecystectomy: А Systematic Review and Network Meta-Analysis. J. Gastrointest. Surg. 2018. 22(7). 1193-1203. doi: 10.1007/s11605-018-3739-4. 
41. Vohra R.S., Hodson J., Pasquali S., et al. Effectiveness of Antibiotic Prophylaxis in Non-emergency Cholecystectomy Using Data from a Population-Based Cohort Study. World J. Surg. 2017. 41(9). 2231-2239. doi: 10.1007/s00268-017-4018-3. 
42. Matsui Y., Satoi S., Hirooka S., Kosaka H., et al. Reappraisal of previously reported meta-analyses on antibiotic prophylaxis for low-risk laparoscopic cholecystectomy: an overview of systematic reviews. BMJ Open. 2018. 8(3). e016666. doi: 10.1136/bmjopen-2017-016666. 
43. Yang J.D., Yu H.C. Prospective Control Study of Clinical Effectiveness of Prophylactic Antibiotics in Laparoscopic Cholecystectomy on Infection Rate. Yonsei Med J. 2021. 62(2). 172-176. doi: 10.3349/ymj.2021.62.2.172. 
44. Colling K.P., Besshoff K.E., Forrester J.D., et al. Surgical Infection Society Guidelines for Antibiotic Use in Patients Undergoing Cholecystectomy for Gallbladder Disease. Surg. Infect. (Larchmt). 2022. 23(4). 339-350. doi: 10.1089/sur.2021.207. 
45. Gamo G.O., Reichardt G.S., Guetter C.R., Pimentel S.K. Risk Factors for Surgical Wound Infection аfter Elective Laparoscopic Cholecystectomy. Arq. Bras. Cir. Dig. 2022. 35. e1655. doi: 10.1590/0102-672020210002e1655.
46. Ullah K., Dogar A.W., Jan Z., et al. Role of antibiotic prophylaxis on surgical site infection prevention in a low-risk population undergoing laparoscopic cholecystectomy: A randomized controlled study. Ann. Med. Surg. (Lond.). 2022. 78. 103804. doi: 10.1016/j.amsu.2022.103804. 
47. Murri R., De Belvis A.G., Fantoni M., et al. Impact of antibiotic stewardship on perioperative antimicrobial prophylaxis. Int. J. Qual. Health Care. 2016. 28(4). 502-507. doi: 10.1093/intqhc/mzw055.
48. Pisano M., Allievi N., Gurusamy K., et al. 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World J. Emerg. Surg. 2020. 15(1). 61. doi: 10.1186/s13017-020-00336-x. 
49. Liang B., Dai M., Zou Z.H. Safety and efficacy of antibiotic prophylaxis in patients undergoing elective laparoscopy cholecystectomy: a systematic review and meta-analysis. J. Gastroenterol. Hepatol. 2016. 31(5). 921-928. doi: 10.1111/jgh.13246.
50. Sajid M.S., Bovis J., Rehman S., Singh K.K. Prophylactic antibiotics at the time of elective cholecystectomy are effective in reducing the post-operative infective complications: a systematic review and meta-analysis. Transl. Gastroenterol. Hepatol. 2018. 3. 22. doi: 10.21037/tgh.2018.04.06. eCollection 2018. 
51. Yang J., Gong S., Lu T., et al. Reduction of risk of infection during elective laparoscopic cholecystectomy using prophylactic antibiotics: a systematic review and meta-analysis. Surg. Endosc. 2021. 35(12). 6397-6412. doi: 10.1007/s00464-021-08658-w. 
52. Kim S.H., Yu H.C., Yang J.D., et al. Role of prophylactic antibiotics in elective laparoscopic cholecystectomy: A systematic review and meta-analysis. Ann. Hepatobiliary Pancreat. Surg. 2018. 22(3). 231-247. doi: 10.14701/ahbps.2018.22.3.231. 
53. Pagani M.A. Jr, Dolfini P.M., et al. 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(10). 1480. doi: 10.3390/antibiotics12101480. 
54. Salim S., Kumar M.N., Tripathi C.D., et al. Pharmacological evaluation of prophylactic anti-microbial use in laparoscopic cholecystectomy: an open labelled study evaluating the concentrations of single dose intravenous ceftriaxone at serum and tissue level. Eur. J. Clin. Pharmacol. 2021. 77(7). 1011-1016. doi: 10.1007/s00228-021-03093-1.
55. Steccanella F., Amoretti P., Barbieri M.R., et al. Antibiotic Prophylaxis for Hepato-Biliopancreatic Surgery — A Systematic Review. Antibiotics (Basel). 2022. 11(2). 194. doi: 10.3390/antibiotics11020194. 
56. Okamoto K., Suzuki K., Takada T., et al. Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. J. Hepatobiliary Pancreat. Sci. 2018. 25(1). 55-72. doi: 10.1002/jhbp.516.
57. Jaafar G., Sandblom G., Lundell L., et al. Antibiotic prophylaxis in acute cholecystectomy revisited: results of a double-blind randomised controlled trial. Langenbecks Arch. Surg. 2020. 405(8). 1201-1207. doi: 10.1007/s00423-020-01977-x.
58. Guler Y., Karabulut Z., Sengul S., Calis H. The effect of antibiotic prophylaxis on wound infections after laparoscopic cholecystectomy: A randomised clinical trial. Int. Wound J. 2019. 16(5). 1164-1170. doi: 10.1111/iwj.13175.
59. Kim E.Y., Yoon Y.C., Choi H.J., et al. Is there a real role of postoperative antibiotic administration for mild-moderate acute cholecystitis? A prospective randomized controlled trial. J. Hepatobiliary Pancreat. Sci. 2017. 24(10). 550-558. doi: 10.1002/jhbp.495.
60. de Santibañes M., Glinka J., Pelegrini P., et al. Extended antibiotic therapy versus placebo after laparoscopic cholecystectomy for mild and moderate acute calculous cholecystitis: A randomized double-blind clinical trial. Surgery. 2018. S0039-6060(18)30030-8. doi: 10.1016/j.surg.2018.01.014.
61. Loozen C.S., Kortram K., Kornmann V.N., et al. Randomized clinical trial of extended versus single-dose perioperative antibiotic prophylaxis for acute calculous cholecystitis. Br. J. Surg. 2017. 104(2). e151-e157. doi: 10.1002/bjs.10406.
62. Singh A., Kaur M., Swaminathan C., et al. Preoperative antibiotic prophylaxis in acute cholecystectomy: a systematic review and meta-analysis of randomised controlled trials. Transl. Gastroenterol. Hepatol. 2023. 8. 37. doi: 10.21037/tgh-23-48. 
63. van Braak W.G., Ponten J.E.H., Loozen C.S., et al. Antibiotic prophylaxis for acute cholecystectomy: PEANUTS II multicentre randomized non-inferiority clinical trial. Br. J. Surg. 2022. 109(3). 267-273. doi: 10.1093/bjs/znab441.
64. Dembinski J., Guérin O., Slim K., et al. Are the recommendations for post-operative antibiotics in patients with grade I or II acute calculous cholecystitis being applied in clinical practice? HPB (Oxford). 2020. 22(7). 1051-1056. doi: 10.1016/j.hpb.2019.10.2442. 
65. Wu P.S., Chou C.K., Hsieh Y.C., et al. Antibiotic use in patients with acute cholecystitis after percutaneous cholecystostomy. J. Chin. Med. Assoc. 2020. 83(2). 134-140. doi: 10.1097/JCMA.0000000000000244.
66. Lee J.M., Kang J.S., Choi Y.J., et al. Suggested use of empirical antibiotics in acute cholecystitis based on bile microbiology and antibiotic susceptibility. HPB (Oxford). 2023. 25(5). 568-576. doi: 10.1016/j.hpb.2023.01.017. 
67. Pašić F., Delibegović S. The Use оf Microbiological аnd Laboratory Data іn the Choice оf Empirical Antibiotic Therapy іn Patients Undergoing Laparoscopic Cholecystectomy — The Role оf Local Antibiograms. Acta Clin. Croat. 2022. 61(2). 171-176. doi: 10.20471/acc.2022.61.02.01.
68.