***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Recent meta-analyses concluded that antibiotic prophylaxis is not warranted in low-risk laparoscopic cholecystectomy . However , most trials in the meta-analyses had a relatively small sample size and were statistically underpowered . In addition , many of the trials mentioned potential cost savings owing to the elimination of prophylactic antibiotics . However , no trial has statistically estimated the cost effectiveness . To evaluate the results of meta-analyses , we conducted a r and omized controlled trial on the role of prophylactic antibiotics in low-risk laparoscopic cholecystectomy with an adequate sample size . Methods From March 2007 to May 2013 , at the Department of Surgery , Kansai Medical University , patients who were scheduled for elective laparoscopic cholecystectomy were r and omly assigned to one of two arms : those who were and were not administered prophylactic antibiotics . The primary endpoint was the occurrence of postoperative infections and secondary endpoints were postoperative hospital stay and medical costs . Findings During the study period , 518 patients were assigned to the Antibiotics group and 519 to the No antibiotics group . Occurrences of surgical site infections , distant infections and overall infections were significantly lower in the Antibiotics group than in the No antibiotics group ( 0.8 vs. 3.7 % , p = 0.001 , OR : 0.205 ( 95%CI : 0.069 to 0.606 ) ; 0.4 vs. 3.1 % , p = 0.0004 , OR : 0.122 ( 95%CI : 0.028 to 0.533 ) ; 1.2 vs. 6.7 % ; p<0.0001 , OR : 0.162 ( 95%CI : 0.068 to 0.389 ) , respectively ) . The postoperative hospital stay was significantly shorter in the Antibiotics group ( mean , SD : 3.69±1.56 vs. 4.07±3.00 ; p = 0.01 ) and the postoperative medical costs were significantly lower in the Antibiotics group ( mean , SD : $ 766±341 vs. 832±670 ; p = 0.047 ) . Multivariable analysis showed that independent risk factors for postoperative infectious complications were no prophylactic antibiotics ( p<0.0001 ) and age 65 or older ( p = 0.006 ) . Conclusions Perioperative administration of prophylactic antibiotics should be recommended in laparoscopic cholecystectomy to prevent postoperative infectious complications and to reduce medical costs . Trial Registration UMIN Clinical Trials Registry UMIN000003749 IMPORTANCE Ninety percent of cases of acute calculous cholecystitis are of mild ( grade I ) or moderate ( grade II ) severity . Although the preoperative and intraoperative antibiotic management of acute calculous cholecystitis has been st and ardized , few data exist on the utility of postoperative antibiotic treatment . OBJECTIVE To determine the effect of postoperative amoxicillin plus clavulanic acid on infection rates after cholecystectomy . DESIGN , SETTING , AND PATIENTS A total of 414 patients treated at 17 medical centers for grade I or II acute calculous cholecystitis and who received 2 g of amoxicillin plus clavulanic acid 3 times a day while in the hospital before and once at the time of surgery were r and omized after surgery to an open-label , noninferiority , r and omized clinical trial between May 2010 and August 2012 . INTERVENTIONS After surgery , no antibiotics or continue with the preoperative antibiotic regimen 3 times daily for 5 days . MAIN OUTCOMES AND MEASURES The proportion of postoperative surgical site or distant infections recorded before or at the 4-week follow-up visit . RESULTS An imputed intention-to-treat analysis of 414 patients showed that the postoperative infection rates were 17 % ( 35 of 207 ) in the nontreatment group and 15 % ( 31 of 207 ) in the antibiotic group ( absolute difference , 1.93 % ; 95 % CI , -8.98 % to 5.12 % ) . In the per- protocol analysis , which involved 338 patients , the corresponding rates were both 13 % ( absolute difference , 0.3 % ; 95 % CI , -5.0 % to 6.3 % ) . Based on a noninferiority margin of 11 % , the lack of postoperative antibiotic treatment was not associated with worse outcomes than antibiotic treatment . Bile cultures showed that 60.9 % were pathogen free . Both groups had similar Clavien complication severity outcomes : 195 patients ( 94.2 % ) in the nontreatment group had a score of 0 to I and 2 patients ( 0.97 % ) had a score of III to V , and 182 patients ( 87.8 % ) in the antibiotic group had a score of 0 to I and 4 patients ( 1.93 % ) had a score of III to V. CONCLUSIONS AND RELEVANCE Among patients with mild or moderate calculous cholecystitis who received preoperative and intraoperative antibiotics , lack of postoperative treatment with amoxicillin plus clavulanic acid did not result in a greater incidence of postoperative infections . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01015417 Introduction Accidental rupture of the gallbladder is an event which occurs in up to 20 % of laparoscopic cholecystectomies , mainly in those where dissection is difficult , or during extraction when the gallbladder is withdrawn directly through the laparoscope port . It has been commonly assumed that contamination by bile in the abdominal cavity could be a cause of infection and lead to the formation of a residual abscess or even to surgical wound infection . It is common practice , therefore , for the surgeon to prescribe the application of an antibiotic at the moment when gallbladder perforation occurs . Objective To compare 2 groups of similar patients , to determine whether administration of antibiotics , started during surgery , is actually useful in reducing the risk of residual abscess or infection in the surgical wound . Patients and Method The study considered a total of 166 patients who had suffered accidental perforation of the gallbladder during elective laparoscopic cholecystectomy . This total was divided at r and om into 2 groups : group A ( 80 patients ) who received a dose of 1 g of Cefotaxime at the moment of gallbladder rupture , followed by 2 more doses at intervals of 8 hours in the immediate postoperative period ; and group B ( 86 patients )  who did not receive any antibiotic treatment at all . The dependent variables observed were surgical wound infection and residual abscess : and the control variables were age , sex , length of operation time , intercurrent illnesses , and American Society of Anesthesiologists ( ASA ) classification . Results Two patients ( 2.5 % ) in group A developed a surgical wound infection , against 3 cases ( 3.4 % ) in group B , the result having no statistical significance . No patients developed residual abscess . In a multivariant analysis , the following were identified as independent factors significantly associated with the onset of surgical wound infection ( P<0.001 ) : diabetes mellitus , being over 60 years of age , operation time lasting longer than 70 minutes , and ASA 3 . Conclusions Routine application of an antibiotic to patients experiencing accidental perforation of the gallbladder during laparoscopic cholecystectomy is not necessary . In the case of patients with diabetes mellitus , those who are older than 60 , or who have an ASA classification of 3 or more , or if the operation itself is likely to last more than 70 minutes , the recommendation is to start antibiotic therapy in the preoperative phase immediately before surgery BACKGROUND Some clinicians administer prophylactic antibiotics routinely before laparoscopic cholecystectomy , and the results of some of the studies in the literature support this practice . We conducted a prospect i ve r and omized trial to determine whether administration of prophylactic antibiotics is necessary during routine laparoscopic cholecystectomy in low-risk patients . STUDY DESIGN Two hundred fifty patients without evidence of acute inflammation , common duct stones , or other indications for antibiotics were r and omized to receive three perioperative doses of cefazolin or no prophylaxis and followed up for complications up to 30 days postoperatively . The primary end point was the occurrence of a major infectious complication , defined as that causing a systemic response , delaying discharge , or leading to readmission . Minor infectious problems were also noted , defined as those causing local symptoms only . RESULTS One hundred twenty-eight patients were r and omized to receive prophylactic antibiotics  ( PA group ) , 122 to receive none  ( NONE group ; two patients in this group were actually given preoperative antibiotics ) . Only one major complication occurred ( in a patient in the NONE group ) , an abscess in the presence of a bile leak , despite the administration of antibiotics when the leak was discovered several days before infectious problems arose . There were four minor problems : two lower urinary tract infections and one superficial wound infection in a NONE patient and one urinary tract infection in a PA patient ( not significant ) ; all were easily managed . The prophylactic antibiotics did not sterilize the bile , and infectious complications were not associated with weight , inflammation found at the time of operation , reported stone or bile spill-age , or conversion to open operation . CONCLUSIONS Prophylactic antibiotics are not necessary for elective laparoscopic cholecystectomy in low-risk patients Background Current recommendations for treating acute calculus cholecystitis include the use of intravenous antibiotics , although these recommendations were never tested scientifically . The aim of this study was to evaluate the role of intravenous antibiotic therapy in patients with mild acute calculus cholecystitis . Methods In this prospect i ve , r and omized controlled trial , 84 patients with a diagnosis of mild acute calculus cholecystitis were r and omly assigned to supportive treatment only or supportive treatment with intravenous antibiotic treatment ( 42 patients in each arm ) . Patients were followed through their index admission and until delayed laparoscopic cholecystectomy was performed . Results The two study groups did not differ in their demographic data or in the clinical presentation and disease severity . Analysis was conducted on the intent-to-treat basis . Patients in the intravenous antibiotics arm resumed a liquid diet earlier ( 1.7 vs. 2.2 days , p = 0.02 ) but did not significantly differ in resumption of regular diet ( 2.8 vs. 3.2 days , p = 0.16 ) or hospital length of stay ( LOS ) ( 3.9 vs. 3.8 days , p = 0.89 ) . Patients in the intravenous antibiotics arm had rates of percutaneous cholecystostomy tube placement ( 12 vs. 5 % , p = 0.43 ) , readmissions ( 19 vs. 13 % , p = 0.73 ) , and perioperative course similar to those not receiving antibiotics . The overall hospital LOS , including initial hospitalization and subsequent cholecystectomy , was similar for both groups ( 5.6 vs. 5.1 days , p = 0.29 ) . Eight ( 19 % ) patients in the supportive arm were crossed over to the intravenous antibiotic arm during the index admission . Conclusions Intravenous antibiotic treatment does not improve the hospital course or early outcome in most of the patients with mild acute calculus cholecystitis Background In patients with symptomatic cholelithiasis ,  laparoscopic cholecystectomy  ( LC ) is the st and ard method of treatment . Laparoscopic cholecystectomy has a low rate of postoperative infections probably owing to smaller wounds and minimal tissue damage compared with the open procedure . Objectives This study assessed the effect of cefazolin prophylaxis on postoperative infection in patients undergoing elective laparoscopic cholecystectomy .  Additionally , we determined the risk factors of cases with postoperative infection . Patients and Methods A total of 753 patients were enrolled in the study . Among these , 206 were excluded from the study . As a result , 547 patients with symptomatic cholelithiasis who underwent elective laparoscopic cholecystectomy were selected for this prospect i ve study . Patients were r and omized consecutively and divided into 2 groups : patients in the cefazolin ( CEF ) group ( n = 278 ) received 1 g of cefazolin and those in the control group ( n = 269 ) received 10 mL of isotonic sodium chloride solution . Patient characteristics and overall surgical outcomes were compared between the groups . All patients were followed for development of postoperative infections . Results Postoperative infections occurred in 4 patients in the CEF group and in 2 patients in the control group ; no significant difference existed in this regard(P = .44 ) . Risk of infection increased in patients with previous cholecystitis and /or endoscopic retro grade cholangiopancreatography ( P < 
    Output:
    
Antibiotic prophylaxis is safe and effective in reducing surgical site infections and global infections during hospitalization or after discharge , and postoperative length of hospital stay in low-risk patients undergoing elective laparoscopic cholecystectomy