Abstract
Background: Surgical site infections (SSI) are common post-operative complications reported in current literature following a laparoscopic cholecystectomy (LC) due to the disturbance of the intraluminal gut microbiota. Surgical antimicrobial prophylaxis (SAP) is the effective administration of antimicrobial agents for the prevention of an SSI. LC is the gold standard treatment for many common benign gallbladder pathologies. The incidence of SSI is becoming less frequently observed in LC, inferring decreased efficacy of SAP. However, the abundant use of antimicrobial agents and ambiguity within the evidence and the current guidelines have resulted in the inappropriate use of SAP. Furthermore, contributing to an increased incidence in the emergence of resistant organisms; an outcome which has significant negative health impacts for healthcare and patients. To ensure optimal antimicrobial efficacy, it is crucial SAP regimens are appropriate and influenced by evidence-based research.
Aim: To examine the published evidence on surgical antimicrobial prophylaxis regimens for patients undergoing LC and to evaluate the Canterbury District Health Board (CDHB) The Pink Book guidelines against this research evidence.
Methodology and Methods: The review utilised an integrative review approach, as described by Whittemore and Knafl (2005). This systematic approach detailed a six-step process for the comprehensive collection, analysis, and synthesis of heterogeneous literature. This process was supported through PRISMA and JBI quality appraisal to allow for the identification and inclusion of the most relevant literature regarding the research aim. Narrative synthesis, as guided by Whittemore and Knafl (2005), facilitated the development of key synthesis and the respective categories and findings.
Results: The search strategy resulted in thirteen articles from academic databases. As per the narrative analysis approach, data extraction, organisation, and analysis facilitated the identification of three key syntheses. These were: (1) SAP for LC affords no statistically significant reduction in SSI incidence (2) patient outcomes (including SSI) after use of SAP for LC, and (3) nuances of the surgical antimicrobial regimen.
Conclusion: This review highlighted the importance of evidence informed SAP recommendations outlined by antimicrobial stewardship (AMS). Clinical adherence is crucial as research indicates SAP being the most common reason for antimicrobial prescription. Thus, SAP use patterns can be substantial contributors to antimicrobial resistance emergence if performed inappropriately (Ierano et al., 2018). In New Zealand, The Pink Book (2020) recommends SAP administration for LC, however, current evidence demonstrated reduced therapeutic benefits and warrants the notion of discontinuing SAP.