Guidelines for Antibiotic Prophylaxis of Cholecystectomies in Norwegian Hospitals

Background: Antibiotic resistance is a global problem that affects the surgical patient population. Guidelines for antibiotic use have been shown to be effective both in terms of protecting individuals undergoing surgery and ensuring appropriate prescribing. More than 5,000 cholecystectomies are performed each year in Norway. However, there are no national guidelines for prophylactic antibiotics. The aim of this study was to chart the existence of local guidelines and whether they were updated and used. This was in order to inform practice and contribute to a rational approach to antibiotic prophylaxis for cholecystectomies. Methods: An online questionnaire was sent to consultant surgeons from every hospital conducting cholecystectomies in Norway. Questions were related to the existence, content, and evaluation of any guidelines concerning prophylactic antibiotic treatment. Results: Thirty-seven of 47 hospitals responded. Overall, 17 of 37 had written guidelines, although this was higher in university hospitals (71%) than in local ones (39%). Not all hospitals with guidelines had them for both laparoscopic and open surgical methods. Most hospitals gave prophylaxis to patients undergoing open cholecystectomies. Guidelines for laparoscopic patients advised no prophylaxis in six institutions, four hospitals recommended prophylaxis of all their patients and others restricted their use to specific subpopulations. The majority with guidelines had revised their information within the last five years. Conclusions: The presence and contents of guidelines vary greatly among Norwegian hospitals. Although many used guidelines to highlight at-risk patients needing antibiotics, there were cases that advocated antibiotics to patients where the benefit is doubtful. We recommend the establishment of a national protocol to optimize antibiotic use, raise awareness of resistance, and promote the treatment of patients at high risk of developing a health care-associated infection.