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Duration of antimicrobial prophylaxis in patients undergoing hepatectomy: a prospective randomized controlled trial
Shinji Togo1, Kuniya Tanaka, Kenichi Matsuo
1Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan. togo@med.yokohama-cu.ac.jp
Objectives:
Although the usefulness of antimicrobial prophylaxis for clean-contaminated surgery has been recognized, only a few randomized controlled studies on the duration of administration after hepatectomy have been performed. We investigated the duration of antimicrobial prophylaxis after hepatectomy.
Methods:
The subjects were 180 patients who underwent hepatectomy without reconstruction of the biliary or intestinal tract between April 2003 and March 2006 at our department. The patients were randomly allocated to groups to be treated with flomoxef sodium as antimicrobial prophylaxis for 2 days (89 patients) or 5 days (91 patients), including the operation day. The presence or absence of systemic inflammatory response syndrome (SIRS) and infections was investigated.
Results:
No significant differences were noted in patient background between the two groups. Infections occurred in seven and six patients in the 2 day and 5 day treatment groups (7.9% and 6.6%), respectively, showing no significant difference between the two groups. No significant difference was noted when the cases were divided into surgical site infections and remote infections. The positive rate of SIRS was significantly higher in the 2 day treatment group than in the 5 day treatment group on days 2 and 3 after surgery. The risk factors in patients who developed infections were blood loss, operation time and the complication of biliary fistula.
Conclusions:
Two day administration of flomoxef sodium may be sufficient for antimicrobial prophylaxis after hepatectomy. However, when SIRS is positive on post-operative day 2, and induction of liver failure is of concern, it may be safer to continue antimicrobial drug administration until SIRS is eliminated.
Insights
Two days of antimicrobial prophylaxis with flomoxef sodium appears sufficient after hepatectomy, with no significant difference in infection rates. However, prolonged prophylaxis may be beneficial if systemic inflammatory response syndrome (SIRS) is present post-surgery.
Area of Science:
- Hepatobiliary Surgery
- Surgical Infection Prevention
- Pharmacodynamics
Background:
- Antimicrobial prophylaxis is crucial for clean-contaminated surgery.
- Limited randomized controlled trials exist on prophylaxis duration post-hepatectomy.
Purpose of the Study:
- To investigate the optimal duration of antimicrobial prophylaxis following hepatectomy.
- To compare 2-day versus 5-day flomoxef sodium prophylaxis.
Main Methods:
- 180 patients undergoing hepatectomy were randomized into two groups.
- Group 1 received 2 days of flomoxef sodium; Group 2 received 5 days.
- Outcomes assessed included infection rates and systemic inflammatory response syndrome (SIRS).
Main Results:
- No significant difference in overall infection rates (7.9% vs. 6.6%) between the 2-day and 5-day groups.
- SIRS positivity was significantly higher in the 2-day group on postoperative days 2 and 3.
- Risk factors for infection included blood loss, operation time, and biliary fistula.
Conclusions:
- A 2-day course of flomoxef sodium may be adequate for antimicrobial prophylaxis after hepatectomy.
- Extended prophylaxis until SIRS resolution is recommended if SIRS is detected post-operatively, especially concerning liver failure.
- Further research may refine prophylaxis guidelines based on patient SIRS status.
