Antibiotic prophylaxis in biliary tract surgery

Even in health, man's environment is one of ubiquitous bacterial presence. As a consequence all wounds are, to a certain extent, contaminated, if only from the normal skin flora. Along with a number of other factors, the development of a wound infection is related to the degree of thls bacterial contamination. Prior to Pasteur's studies on bacteriology and Lister's application of them to wounds most, if not all, wounds became infected. The treatment of established wound infections, however, is beyond the scope of this thesis. Attention will focus on the prevention of wound infections. Lowering the incidence of wound infections can be directed to (l) destroying organisms after they have reached the wonnd, and (2) preventing the arrival or growth of organisms in subcutaneous tissues. The aim of antibiotic prophylaxis is to prevent any bacteria, released into the operative field 2.t the time of surgery, from multiplying.. The use of antibiotics for prophylaxis has only recently been accepted as a useful adjuvant to the established principles of antisepsis in surgery. In cholecystectomy, the problems of operative mortality and serious morbidity have been largely solved. At present, the most common complication of traditional cholecystectomy is wound infection5. The importance of reducing this source of morbidity is obvious. Presented in this thesis is a randomized study designed to assess the efficacy of a preoperative, single-dose prophylaxis of cefuroxime. This introductory chapter of the thesis includes some historical aspects of asepsis, antisepsis, and antimicrobial prophylaxis of wound infection, as well as the history of cholecystectomy. The aetiology of wound infections and the bacteriology of bile are also discussed in this chapter. Furthermore the basic principles of antibiotic prophylaxis and the objectives of the study are outlined. The following five chapters include the original studies. At the end of the thesis a general discussion and conclusions drawn from the study are presented. The thesis is concluded with a summary

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