A prospective randomized study to assess the optimal duration of intravenous antimicrobial prophylaxis in elective gastric cancer surgery.

The duration of antimicrobial prophylaxis in gastric cancer surgery is not yet established. This prospective randomized study was performed to confirm the noninferiority of single-dose versus multiple-dose antimicrobial prophylaxis in terms of the incidence of surgical-site infection in gastric cancer surgery. Three hundred twenty-five patients undergoing elective resection for gastric cancer were randomized to receive only single-dose cefazolin (1 g) during surgery (single-dose group) or an additional 5 doses every 12 hours postoperatively (multiple-dose group). The overall incidence of surgical-site infections was 9.1% in the single-dose group and 6.2% in the multiple-dose group [difference (95% confidence interval): -2.9% (-5.9%-0.0%)]. Multivariate logistic regression analysis identified blood loss, being overweight, and advanced age as significant independent risk factors for surgical-site infection. Single-dose antimicrobial prophylaxis seemed to be acceptable, and choosing multiple-dose prophylaxis may have little impact on the prevention of surgical-site infections in elective gastric cancer surgery.

[1]  R. Castoldi,et al.  Prophylactic Use of Cefotaxime in Biliary Surgery Comparison of Single-Dose versus Multiple-Dose Schedule , 2012, Drugs.

[2]  You-Cheng Zhang,et al.  Drain versus No-Drain after Gastrectomy for Patients with Advanced Gastric Cancer: Systematic Review and Meta-Analysis , 2011, Digestive Surgery.

[3]  Y. K. Park,et al.  General perioperative management of gastric cancer patients at high-volume centers , 2011, Gastric Cancer.

[4]  A. Tanaka,et al.  Optimal duration of prophylactic antibiotic administration for elective colon cancer surgery: A randomized, clinical trial. , 2011, Surgery.

[5]  Z. Dong,et al.  Abdominal drainage versus no drainage post gastrectomy for gastric cancer. , 2011, The Cochrane database of systematic reviews.

[6]  M. Monden,et al.  Age as an independent risk factor for surgical site infections in a large gastrointestinal surgery cohort in Japan. , 2010, The Journal of hospital infection.

[7]  K. Kumamoto,et al.  Distal gastrectomy via minilaparotomy for non-overweight patients with T1N0-1 gastric cancer: initial experience of 30 cases. , 2010, International journal of surgery.

[8]  T. Miyazaki,et al.  Short-term intravenous antimicrobial prophylaxis in combination with preoperative oral antibiotics on surgical site infection and methicillin-resistant Staphylococcus aureus infection in elective colon cancer surgery: Results of a prospective randomized trial , 2009, Surgery Today.

[9]  I. Ekiz,et al.  Risk factors for surgical site infection after gastrectomy with D2 lymphadenectomy , 2009, Surgery Today.

[10]  T. Kubota,et al.  Surgical site infection risk factors identified by multivariate analysis for patient undergoing laparoscopic, open colon, and gastric surgery. , 2008, American journal of infection control.

[11]  H. Kuwano,et al.  Prolonged antibiotic prophylaxis longer than 24 hours does not decrease surgical site infection after elective gastric and colorectal surgery. , 2008, Hepato-gastroenterology.

[12]  H. Yamaue,et al.  Prevention of postoperative infections by administration of antimicrobial agents immediately before surgery for patients with gastrointestinal cancers. , 2007, Hepato-gastroenterology.

[13]  M. Ohue,et al.  Randomized, multicenter trial of antibiotic prophylaxis in elective colorectal surgery: single dose vs 3 doses of a second-generation cephalosporin without metronidazole and oral antibiotics. , 2007, Archives of surgery.

[14]  Y. Mohri,et al.  Randomized clinical trial of single‐ versus multiple‐dose antimicrobial prophylaxis in gastric cancer surgery , 2007, The British journal of surgery.

[15]  Toshio Shimizu,et al.  Influence of Overweight on Surgical Complications for Gastric Cancer: Results From a Randomized Control Trial Comparing D2 and Extended Para-aortic D3 Lymphadenectomy (JCOG9501) , 2007, Annals of Surgical Oncology.

[16]  D. Dunt,et al.  SURGICAL ANTIBIOTIC PROPHYLAXIS IN SMALLER HOSPITALS , 2006, ANZ journal of surgery.

[17]  D. Fry,et al.  Use of antimicrobial prophylaxis for major surgery: baseline results from the National Surgical Infection Prevention Project. , 2005, Archives of surgery.

[18]  H. Tsukuma,et al.  Multicenter phase II study of antimicrobial prophylaxis in low-risk patients undergoing distal gastrectomy for gastric cancer , 2005, Gastric Cancer.

[19]  T. Horan,et al.  Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. , 1999, American journal of infection control.

[20]  Teresa C. Horan,et al.  Guideline for Prevention of Surgical Site Infection, 1999 , 1999, Infection Control & Hospital Epidemiology.

[21]  T. Horan,et al.  Guideline for prevention of surgical site infection. , 2000, Bulletin of the American College of Surgeons.

[22]  Japanese Gastric Cancer Association.  Japanese Classification of Gastric Carcinoma – 2nd English Edition – , 1998, Gastric Cancer.

[23]  J. Brokloff.  Does intraoperative blood loss affect antibiotic serum and tissue concentrations , 1997 .

[24]  K. Flegal,et al.  Assessing obesity: classification and epidemiology. , 1997, British medical bulletin.

[25]  P. Lipsett,et al.  Does intraoperative blood loss affect antibiotic serum and tissue concentrations? , 1996, Archives of surgery.

[26]  P. Schmitz,et al.  Prophylactic use of cefuroxime in biliary tract surgery: Randomized controlled trial of single versus multiple dose in high‐risk patients , 1993, The British journal of surgery.

[27]  F. Moesgaard,et al.  Antibiotic prophylaxis in high risk biliary surgery: one dose of ceftriaxone compared with two doses of cefuroxime. , 1991, The European journal of surgery = Acta chirurgica.

[28]  B. Guglielmo,et al.  Effect of surgical blood loss and volume replacement on antibiotic pharmacokinetics. , 1989, The Annals of thoracic surgery.

[29]  L. E. Curtis,et al.  Antibiotic prophylaxis in high-risk biliary operations: multicenter trial of single preoperative ceftriaxone versus multidose cefazolin. , 1984, American journal of surgery.