human
***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 In the absence of r and omized controlled trials with sufficient power to assess the effectiveness of prophylactic antibiotics ( PA ) , the best evidence is provided by large population -based register studies . Methods The Swedish Register of Gallstone Surgery and ERCP ( GallRiks ) started in May 2005 and reached 75 % national coverage in 2007 . During 2006 and 2007 , a total of 16,400 operations were registered in GallRiks . In the present study , all elective procedures performed in 2006–2007 in units performing at least 25 operations annually were included in an analysis of the risk for postoperative infectious complications Results Altogether 10,927 procedures were performed 2006–2007 .  Univariate logistic regression analysis revealed a paradoxical increase in postoperative infectious complications requiring antibiotic treatment and postoperative abscess if PA were given ( p < 0.05 ) . This increase disappeared in multivariate analysis with adjustment for age , gender , presence of cholecystitis , accidental gallbladder perforation , and presence of bile duct stones . Conclusion No benefit from PA was seen in this study on elective cholecystectomy . Although a r and omized controlled trial could possibly show a reduction in the risk for postoperative infectious complications not detected in this study , such a reduction must be weighed against the risk of promoting drug resistance by the widespread use of PA Abstract Background There is a variation in the administration of antibiotics prophylaxis to reduce the perceived risk of SSI in patients undergoing non-emergency cholecystectomy . The aim of this study was to determine the effectiveness of antibiotic prophylaxis following non-emergency cholecystectomy to prevent 30-day superficial surgical site infections ( SSIs ) using non-selected , nationally collected , prospect i ve data . Methods Data were extracted from the CholeS study , which examined and independently vali date d the outcomes on consecutive patients following non-emergency cholecystectomy across 166 hospitals in the UK and Irel and . Patients who received antibiotic prophylaxis were exact matched to those who did not on variables associated with antibiotic prophylaxis . The primary outcome of interest was superficial SSI , and secondary outcomes included deep SSI , readmissions , complications and re- interventions within 30 days . Results Out of a total of 7327 patients included in the study , 4468 ( 61 % ) received antibiotic prophylaxis . These were matched to patients who did not receive antibiotic prophylaxis on a range of demographic and surgical factors , leaving 1269 pairs of patients for analysis . Within this cohort , patients receiving antibiotic prophylaxis had significantly lower rates of superficial SSI ( 0.7 % vs. 2.3 % , p = 0.001 ) and all-cause complications ( 5.8 vs. 8.0 % , p = 0.031 ) , but similar rates of deep SSI ( 1.0 vs. 1.4 % , p = 0.473 ) , readmissions ( 5.2 vs. 6.2 % , p = 0.302 ) and re- interventions ( 2.6 vs. 3.7 % , p = 0.093 ) . The number needed to treat to prevent one superficial SSI was 45 ( 95 % confidence interval 24–662 ) . Conclusions Antibiotics appear effective at reducing SSI after non-emergency cholecystectomy . However , due to the high number needed to treat it is unclear whether they provide a worthwhile clinical benefit to patients Background : Acute calculous cholecystitis ( ACC ) is the most common complication of cholelithiasis . Laparoscopic cholecystectomy ( LC ) is the gold st and ard treatment in mild and moderate forms . Currently there is consensus for the use of antibiotics in the preoperative phase of ACC . However , the need for antibiotic therapy after surgery remains undefined with a low level of scientific evidence . Methods : The CHART ( Cholecystectomy Antibiotic R and omised Trial ) study is a single‐center , prospect i ve , double blind , and r and omized trial . Patients with mild to moderate ACC operated by LC were r and omly assigned to receive antibiotic ( amoxicillin/clavulanic acid ) or placebo treatment for 5 consecutive days . The primary endpoint was postoperative infectious complications . Secondary endpoints were as follows : ( 1 ) duration of hospital stay , ( 2 ) readmissions , ( 3 ) reintervention , and ( 4 ) overall mortality . Results : In the per‐ protocol analysis , 6 of 104 patients ( 5.8 % ) in the placebo arm and 6 of 91 patients ( 6.6 % ) in the antibiotic arm developed postoperative infectious complications ( absolute difference 0.82 ( 95 % confidence interval , −5.96 to 7.61 , P = .81 ) . The median hospital stay was 3 days . There was no mortality . There were no differences regarding readmissions and reoperations between the 2 groups . Conclusion : Although this trial failed to show noninferiority of postoperative placebo compared to antibiotic treatment after LC for mild and moderate ACC within a noninferiority margin of 5 % , the use of antibiotics in the postoperative period does not seem justified , because it was not associated with a decrease in the incidence of infectious and other types of morbidity in the present study 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 ABSTRACT Background : Elective laparoscopic cholecystectomy has very low risk for infectious complications , ranging the infection rate from 0.4 % to 1.1 % . Many surgeons still use routine antibiotic prophylaxis Aim : Evaluate the real impact of antibiotic prophylaxis in elective laparoscopic cholecystectomies in low risk patients . Method : Prospect i ve , r and omized and double-blind study . Were evaluated 100 patients that underwent elective laparoscopic cholecystectomy  divided in two groups : group A ( n=50 ) , patients that received prophylaxis using intravenous Cephazolin ( 2 g ) during anesthetic induction and group B ( n=50 ) , patients that did n't receive any antibiotic prophylaxis . The outcome evaluated were infeccious complications at surgical site . The patients were review ed seven and 30 days after surgery . Results : There was incidence of 2 % in infection complications in group A and 2 % in group B. There was no statistical significant difference of infectious complications ( p=0,05 ) between the groups . The groups were homogeneous and comparable . Conclusion : The use of the antibiotic prophylaxis in laparoscopic cholecystectomy in low risk patients does n't provide any significant benefit in the decrease of surgical wound infection 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 
    Output:
    
agent
Conclusions The use of prophylactic antibiotics is effective for reducing the incidence of SSI and superficial SSI but is not effective for preventing deep SSI in low-risk patients who underwent elective laparoscopic cholecystectomy
***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 In the absence of r and omized controlled trials with sufficient power to assess the effectiveness of prophylactic antibiotics ( PA ) , the best evidence is provided by large population -based register studies . Methods The Swedish Register of Gallstone Surgery and ERCP ( GallRiks ) started in May 2005 and reached 75 % national coverage in 2007 . During 2006 and 2007 , a total of 16,400 operations were registered in GallRiks . In the present study , all elective procedures performed in 2006–2007 in units performing at least 25 operations annually were included in an analysis of the risk for postoperative infectious complications Results Altogether 10,927 procedures were performed 2006–2007 .  Univariate logistic regression analysis revealed a paradoxical increase in postoperative infectious complications requiring antibiotic treatment and postoperative abscess if PA were given ( p < 0.05 ) . This increase disappeared in multivariate analysis with adjustment for age , gender , presence of cholecystitis , accidental gallbladder perforation , and presence of bile duct stones . Conclusion No benefit from PA was seen in this study on elective cholecystectomy . Although a r and omized controlled trial could possibly show a reduction in the risk for postoperative infectious complications not detected in this study , such a reduction must be weighed against the risk of promoting drug resistance by the widespread use of PA Abstract Background There is a variation in the administration of antibiotics prophylaxis to reduce the perceived risk of SSI in patients undergoing non-emergency cholecystectomy . The aim of this study was to determine the effectiveness of antibiotic prophylaxis following non-emergency cholecystectomy to prevent 30-day superficial surgical site infections ( SSIs ) using non-selected , nationally collected , prospect i ve data . Methods Data were extracted from the CholeS study , which examined and independently vali date d the outcomes on consecutive patients following non-emergency cholecystectomy across 166 hospitals in the UK and Irel and . Patients who received antibiotic prophylaxis were exact matched to those who did not on variables associated with antibiotic prophylaxis . The primary outcome of interest was superficial SSI , and secondary outcomes included deep SSI , readmissions , complications and re- interventions within 30 days . Results Out of a total of 7327 patients included in the study , 4468 ( 61 % ) received antibiotic prophylaxis . These were matched to patients who did not receive antibiotic prophylaxis on a range of demographic and surgical factors , leaving 1269 pairs of patients for analysis . Within this cohort , patients receiving antibiotic prophylaxis had significantly lower rates of superficial SSI ( 0.7 % vs. 2.3 % , p = 0.001 ) and all-cause complications ( 5.8 vs. 8.0 % , p = 0.031 ) , but similar rates of deep SSI ( 1.0 vs. 1.4 % , p = 0.473 ) , readmissions ( 5.2 vs. 6.2 % , p = 0.302 ) and re- interventions ( 2.6 vs. 3.7 % , p = 0.093 ) . The number needed to treat to prevent one superficial SSI was 45 ( 95 % confidence interval 24–662 ) . Conclusions Antibiotics appear effective at reducing SSI after non-emergency cholecystectomy . However , due to the high number needed to treat it is unclear whether they provide a worthwhile clinical benefit to patients Background : Acute calculous cholecystitis ( ACC ) is the most common complication of cholelithiasis . Laparoscopic cholecystectomy ( LC ) is the gold st and ard treatment in mild and moderate forms . Currently there is consensus for the use of antibiotics in the preoperative phase of ACC . However , the need for antibiotic therapy after surgery remains undefined with a low level of scientific evidence . Methods : The CHART ( Cholecystectomy Antibiotic R and omised Trial ) study is a single‐center , prospect i ve , double blind , and r and omized trial . Patients with mild to moderate ACC operated by LC were r and omly assigned to receive antibiotic ( amoxicillin/clavulanic acid ) or placebo treatment for 5 consecutive days . The primary endpoint was postoperative infectious complications . Secondary endpoints were as follows : ( 1 ) duration of hospital stay , ( 2 ) readmissions , ( 3 ) reintervention , and ( 4 ) overall mortality . Results : In the per‐ protocol analysis , 6 of 104 patients ( 5.8 % ) in the placebo arm and 6 of 91 patients ( 6.6 % ) in the antibiotic arm developed postoperative infectious complications ( absolute difference 0.82 ( 95 % confidence interval , −5.96 to 7.61 , P = .81 ) . The median hospital stay was 3 days . There was no mortality . There were no differences regarding readmissions and reoperations between the 2 groups . Conclusion : Although this trial failed to show noninferiority of postoperative placebo compared to antibiotic treatment after LC for mild and moderate ACC within a noninferiority margin of 5 % , the use of antibiotics in the postoperative period does not seem justified , because it was not associated with a decrease in the incidence of infectious and other types of morbidity in the present study 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 ABSTRACT Background : Elective laparoscopic cholecystectomy has very low risk for infectious complications , ranging the infection rate from 0.4 % to 1.1 % . Many surgeons still use routine antibiotic prophylaxis Aim : Evaluate the real impact of antibiotic prophylaxis in elective laparoscopic cholecystectomies in low risk patients . Method : Prospect i ve , r and omized and double-blind study . Were evaluated 100 patients that underwent elective laparoscopic cholecystectomy  divided in two groups : group A ( n=50 ) , patients that received prophylaxis using intravenous Cephazolin ( 2 g ) during anesthetic induction and group B ( n=50 ) , patients that did n't receive any antibiotic prophylaxis . The outcome evaluated were infeccious complications at surgical site . The patients were review ed seven and 30 days after surgery . Results : There was incidence of 2 % in infection complications in group A and 2 % in group B. There was no statistical significant difference of infectious complications ( p=0,05 ) between the groups . The groups were homogeneous and comparable . Conclusion : The use of the antibiotic prophylaxis in laparoscopic cholecystectomy in low risk patients does n't provide any significant benefit in the decrease of surgical wound infection 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 
    Output:
    