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Efficacy of Single-Dose Antimicrobial Prophylaxis for Preventing Surgical Site Infection in Radical Gastrectomy for Gastric Carcin

  • Han, Ji Hoon (Department of Surgery, Chonnam National University Hwasun Hospital) ;
  • Jeong, Oh (Department of Surgery, Chonnam National University Hwasun Hospital) ;
  • Ryu, Seong Yeop (Department of Surgery, Chonnam National University Hwasun Hospital) ;
  • Jung, Mi Ran (Department of Surgery, Chonnam National University Hwasun Hospital) ;
  • Park, Young Kyu (Department of Surgery, Chonnam National University Hwasun Hospital)
  • Received : 2014.05.11
  • Accepted : 2014.08.06
  • Published : 2014.09.30

Abstract

Purpose: Information regarding antimicrobial prophylaxis (AMP) for gastric cancer surgery is limited. The present study investigated the efficacy of single-dose AMP for the prevention of surgical site infection (SSI) in patients undergoing gastrectomy for gastric carcinoma. Materials and Methods: Between 2011 and 2013, 1,330 gastric carcinoma surgery patients were divided into two AMP administration groups depending on the duration of treatment. Postoperative outcomes including morbidity and SSI were compared between the two groups overall and in matched patients. Risk factors for SSI were analyzed. Results: The extended group (n=1,129) received AMP until postoperative day 1 and the single-dose group (n=201) received single-dose AMP only during an operation. Postoperatively, there were no significant differences between the two groups with respect to overall morbidity, mortality, or length of hospital stay. The SSI rate of the single-dose group was not significantly different from that of the extended group overall (4.5% vs. 5.5%, respectively, P=0.556) or in matched patients (4.5% vs. 4.0%, respectively, P=0.801). There was no increase in the SSI rate of the single-dose group compared to the extended group in subgroups based on different clinicopathological and operative factors. Univariate and multivariate analyses revealed male gender, open surgery, and operating time (${\geq}180$ minutes) as independent risk factors for SSI. Conclusions: Single-dose AMP showed no increase in the postoperative SSI rate compared to postoperative extended use in patients undergoing gastrectomy for gastric carcinoma. The efficacy of single-dose AMP requires further investigation in randomized clinical trials specific to gastric cancer surgery.

Keywords

References

  1. Burke JP. Infection control - a problem for patient safety. N Engl J Med 2003;348:651-656. https://doi.org/10.1056/NEJMhpr020557
  2. National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470-485. https://doi.org/10.1016/j.ajic.2004.10.001
  3. Imamura H, Furukawa H, Iijima S, Sugihara S, Tsujinaka T, Tsukuma H, et al. Multicenter phase II study of antimicrobial prophylaxis in low-risk patients undergoing distal gastrectomy for gastric cancer. Gastric Cancer 2006;9:32-35. https://doi.org/10.1007/s10120-005-0354-3
  4. Imai E, Ueda M, Kanao K, Miyaki K, Kubota T, Kitajima M. Surgical site infection surveillance after open gastrectomy and risk factors for surgical site infection. J Infect Chemother 2005;11:141-145. https://doi.org/10.1007/s10156-005-0379-X
  5. Migita K, Takayama T, Matsumoto S, Wakatsuki K, Enomoto K, Tanaka T, et al. Risk factors for surgical site infections after elective gastrectomy. J Gastrointest Surg 2012;16:1107-1115. https://doi.org/10.1007/s11605-012-1838-1
  6. Ozalp N, Zulfikaroglu B, Gocmen E, Acar A, Ekiz I, Koc M, et al. Risk factors for surgical site infection after gastrectomy with D2 lymphadenectomy. Surg Today 2009;39:1013-1015. https://doi.org/10.1007/s00595-008-3984-3
  7. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013;70:195-283. https://doi.org/10.2146/ajhp120568
  8. Dellinger EP, Gross PA, Barrett TL, Krause PJ, Martone WJ, McGowan JE Jr, et al. Quality standard for antimicrobial prophylaxis in surgical procedures. Infectious Diseases Society of America. Clin Infect Dis 1994;18:422-427. https://doi.org/10.1093/clinids/18.3.422
  9. Gilbert DN, Moellering RC, Sande MA, eds. The Sanford Guide to Antimicrobial Therapy. 33rd ed. Hyde Park, VT: Antimicrobial Therapy, 2003:123-124.
  10. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250-278. https://doi.org/10.1086/501620
  11. Page CP, Bohnen JM, Fletcher JR, McManus AT, Solomkin JS, Wittmann DH. Antimicrobial prophylaxis for surgical wounds. Guidelines for clinical care. Arch Surg 1993;128:79-88. https://doi.org/10.1001/archsurg.1993.01420130087014
  12. Van Eyk N, van Schalkwyk J; Infectious Diseases Committee. Antibiotic prophylaxis in gynaecologic procedures. J Obstet Gynaecol Can 2012;34:382-391. https://doi.org/10.1016/S1701-2163(16)35222-7
  13. Choudhary A, Bechtold ML, Puli SR, Othman MO, Roy PK. Role of prophylactic antibiotics in laparoscopic cholecystectomy: a meta-analysis. J Gastrointest Surg 2008;12:1847-1853; discussion 1853. https://doi.org/10.1007/s11605-008-0681-x
  14. McDonald M, Grabsch E, Marshall C, Forbes A. Single- versus multiple-dose antimicrobial prophylaxis for major surgery: a systematic review. Aust N Z J Surg 1998;68:388-396. https://doi.org/10.1111/j.1445-2197.1998.tb04785.x
  15. Song F, Glenny AM. Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomized controlled trials. Br J Surg 1998;85:1232-1241. https://doi.org/10.1046/j.1365-2168.1998.00883.x
  16. Imamura H, Kurokawa Y, Tsujinaka T, Inoue K, Kimura Y, Iijima S, et al. Intraoperative versus extended antimicrobial prophylaxis after gastric cancer surgery: a phase 3, open-label, randomised controlled, non-inferiority trial. Lancet Infect Dis 2012;12:381-387. https://doi.org/10.1016/S1473-3099(11)70370-X
  17. Mohri Y, Tonouchi H, Kobayashi M, Nakai K, Kusunoki M; Mie Surgical Infection Research Group. Randomized clinical trial of single- versus multiple-dose antimicrobial prophylaxis in gastric cancer surgery. Br J Surg 2007;94:683-688. https://doi.org/10.1002/bjs.5837
  18. Ahn HS, Yook JH, Park CH, Park YK, Yu W, Lee MS, et al. General perioperative management of gastric cancer patients at high-volume centers. Gastric Cancer 2011;14:178-182. https://doi.org/10.1007/s10120-011-0012-x
  19. Sumiyama Y, Takesue Y. Current status of prophylactic antibiotic therapy for prevention of postoperative infections after gastrointestinal surgery: a questionnaire covering 3,823 surgeons. Jpn J Chemother 2004;52:474-485.
  20. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 2011;14:113-123. https://doi.org/10.1007/s10120-011-0042-4
  21. Sobin L, Gospodarowicz M, Wittekind C, eds. TNM classification of Malignant Tumours. 7th ed. International Union Against Cancer (UICC). New York: Wiley, 2009.
  22. Jung MR, Park YK, Seon JW, Kim KY, Cheong O, Ryu SY. Definition and classification of complications of gastrectomy for gastric cancer based on the accordion severity grading system. World J Surg 2012;36:2400-2411. https://doi.org/10.1007/s00268-012-1693-y
  23. Newgard CD, Hedges JR, Arthur M, Mullins RJ. Advanced statistics: the propensity score--a method for estimating treatment effect in observational research. Acad Emerg Med 2004;11:953-961.
  24. Wang F, Chen XZ, Liu J, Yang K, Zhang B, Chen ZX, et al. Short-term versus long-term administration of single prophylactic antibiotic in elective gastric tumor surgery. Hepatogastroenterology 2012;59:1784-1788.
  25. Suehiro T, Hirashita T, Araki S, Matsumata T, Tsutsumi S, Mochiki E, et al. Prolonged antibiotic prophylaxis longer than 24 hours does not decrease surgical site infection after elective gastric and colorectal surgery. Hepatogastroenterology 2008;55:1636-1639.
  26. Hirao M, Tsujinaka T, Imamura H, Kurokawa Y, Inoue K, Kimura Y, et al; Osaka Gastrointestinal Cancer Chemotherapy Study Group (OGSG). Overweight is a risk factor for surgical site infection following distal gastrectomy for gastric cancer. Gastric Cancer 2013;16:239-244. https://doi.org/10.1007/s10120-012-0174-1
  27. Utsumi M, Shimizu J, Miyamoto A, Umeshita K, Kobayashi T, Monden M, et al. Age as an independent risk factor for surgical site infections in a large gastrointestinal surgery cohort in Japan. J Hosp Infect 2010;75:183-187. https://doi.org/10.1016/j.jhin.2010.01.021
  28. Sessler DI, Akca O. Nonpharmacological prevention of surgical wound infections. Clin Infect Dis 2002;35:1397-1404. https://doi.org/10.1086/344275

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