PIPERACILLIN VERSUS CEFAZOLIN GIVEN PERIOPERATIVELY TO HIGH-RISK PATIENTS WHO UNDERGO OPEN CHOLECYSTECTOMY - A DOUBLE-BLIND, RANDOMIZED TRIAL

Objective: To study the efficacy, microbiologic features and toxicity of prophylactic cefazolin versus prophylactic piperacillin in high-ris k patients who undergo open cholecystectomy. Design: Double-blind rand omized trial with follow-up for 6 weeks postoperatively. Setting: An 8 50-bed community hospital, located in a major Canadian city. Patients admitted to hospital who satisfied published criteria for being at hig h-risk for infection after open cholecystectomy were entered into the protocol, and those who satisfied the criteria and provided consent we re entered into the study. Eighty-one patients were randomly assigned by computer to receive either piperacillin or cefazolin as the prophyl actic agent. Interventions: Open cholecystectomy. Main outcome: Provid es detailed information on the organisms found in the biliary tree in patients with acute cholecystitis, assesses the in-vitro activity of c efazolin versus piperacillin against the isolated organisms, expecting that piperacillin would be much more active against isolated anaerobe s and gram-negative bacteria. Results: Bactobilia was documented in 42 % of patients in the cefazolin group and 29% of patients in the pipera cillin group. Piperacillin was active in vitro against 94% of all isol ates versus 56% for cefazolin (p < 0.005, McNemar's test). Adverse eff ects 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 pati ents who undergo open cholecystectomy. However, piperacillin had a muc h wider spectrum of in-vitro activity against the isolated pathogens, especially Enterococcus sp., Enterobacter cloacae and the anaerobes.