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A Randomized Study of Cefuroxime vs Ampicillin-Sulbactam

Athanasios Dervisoglou, MD; Sotirios Tsiodras, MD, DSc; Kyriaki Kanellakopoulou, MD; Stamatios Pinis, MD; Nearchos Galanakis, MD; Stephanos Pierakakis, MD; Panagiotis Giannakakis, MD; Stavroula Liveranou, MD; Panagiota Ntasiou, MD; Efstathia Karampali, MD; Christos Iordanou, MD; Helen Giamarellou, MD, DSc

Arch Surg. 2006;141:1162-1167.

Hypothesis  Cephalosporins are widely used and considered to be effective as prophylaxis in biliary surgery. Nevertheless, they lack activity against enterococci. We conducted a study to compare the efficacy of ampicillin-sulbactam vs cefuroxime in preventing surgical site infections following elective cholecystectomy.

Design  A prospective randomized controlled trial.

Setting  A major tertiary care hospital.

Patients  Four hundred eighteen randomized patients (of 549 total), who from July 2002 to August 2004 underwent elective open or laparoscopic cholecystectomy with prospective assessment for development of surgical site infections for 1 month postoperatively.

Intervention  A single intravenous dose of 1.5 g of cefuroxime (group A, n = 207) or 3 g of ampicillin-sulbactam (group B, n = 211) was administered during induction of anesthesia. Bile and gallbladder mucosal cultures were taken intraoperatively from all patients.

Main Outcome Measure  Number of postoperative surgical site infections.

Results  A postoperative surgical site infection was noted in 19 (4.5%) of 418 patients, 18 from group A and 1 from group B (P<.001). In the group that received cefuroxime, 15 (83.3%) of 18 surgical site infections were due to Enterococcus species. Intraoperative bactibilia as well as intraoperative gallbladder rupture were associated with surgical site infections (P<.001).

Conclusions  A single dose of ampicillin-sulbactam favored better compared with cefuroxime for prevention of postoperative surgical site infections due to Enterococcus species after elective cholecystectomy. Ampicillin-sulbactam may be a better agent for antimicrobial prophylaxis in high-risk patients undergoing elective cholecystectomy, especially in a setting where the incidence of enterococcal infections is higher.

Author Affiliations: Second Department of Surgery, "Agios Panteleimon" State General Hospital, Piraeus, Greece (Drs Dervisoglou, Pinis, Galanakis, Pierakakis, Giannakakis, Liveranou, Ntasiou, Karampali, Iordanou, and Giamarellou), and Fourth Department of Internal Medicine and Infectious Diseases, University of Athens Medical School, Athens, Greece (Drs Tsiodras, Kanellakopoulou, and Giamarellou).

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