Antibiotic prophylaxis in oesophageal surgery.

Area of Science:

• Surgical Infectious Diseases
• Pharmacology and Therapeutics
• Gastrointestinal Surgery

Background:

• Antibiotic prophylaxis is crucial in preventing surgical site infections (SSIs) in gastrointestinal surgery.
• Optimal antibiotic regimens for esophageal surgery require further investigation to minimize infectious complications.

Purpose of the Study:

• To evaluate the efficacy of different antibiotic prophylaxis strategies in patients undergoing esophageal surgery.
• To compare the incidence of infective complications associated with various antibiotic regimens.

Main Methods:

• A prospective randomized study included 226 patients undergoing esophageal surgery.
• Patients were divided into two main groups based on upper alimentary tract opening during surgery.
• Group 1 (n=129) received different cefuroxime (CFX) and metronidazole (MTR) regimens, while Group 2 (n=97) received CFX alone or with a shorter duration.

Main Results:

• Subgroup C (CFX + MTR at induction) and Subgroup A (CFX alone, longer duration) had significantly higher infection rates (43.9% and 21.4%) compared to Subgroup B (CFX + MTR, longer duration) (8.6%).
• In Group 2, Subgroup D (CFX alone, shorter duration) showed a higher infection rate (10.6%) than Subgroup E (CFX alone, 2-day duration) (2%).
• The most significant differences in infection rates were observed in patients undergoing esophagectomy.

Conclusions:

• Combination antibiotic prophylaxis with cefuroxime and metronidazole is superior to cefuroxime alone in reducing infective complications in esophageal surgery.
• A shorter duration of antibiotic prophylaxis may be sufficient for patients not undergoing upper alimentary tract opening.
• Optimized antibiotic strategies are essential for improving patient outcomes in esophageal surgery.