Antibiotic prophylaxis in thyroid surgery: a preliminary multicentric Italian experience

Area of Science:

• Surgical Infection Prevention
• Endocrine Surgery
• Clinical Evidence Synthesis

Background:

• Post-thyroidectomy wound infections are rare, leading international guidelines to not routinely recommend systemic antibiotic prophylaxis.
• Existing clinical evidence supporting the benefits of antibiotic prophylaxis in this patient population is limited.
• The necessity and efficacy of routine antibiotic prophylaxis following thyroidectomy remain debated.

Purpose of the Study:

• To evaluate the efficacy of standard antibiotic prophylaxis (sulbactam/ampicillin) in preventing post-operative wound infections after thyroidectomy.
• To determine if prophylactic antibiotics offer benefits in specific patient subgroups undergoing thyroidectomy.
• To provide preliminary data for future, larger-scale randomized controlled trials (RCTs).

Main Methods:

• A multicentric, randomized, double-blind trial involving 500 patients undergoing thyroidectomy for goiter or thyroid carcinoma.
• Patients were randomized into two groups: one receiving sulbactam/ampicillin prophylaxis (250 patients), and the other receiving no antibiotic prophylaxis (250 patients).
• Exclusion criteria included age over eighty, concomitant diseases, cardiac valvulopathies, immunosuppressive treatment, and severe obesity.

Main Results:

• Prophylactic antibiotic treatment showed no significant benefit in preventing post-operative wound infections in the studied patient cohort.
• The findings suggest that antibiotic prophylaxis is not beneficial for patients under eighty without specific comorbidities or treatments.
• This preliminary RCT indicates a potential lack of necessity for routine antibiotic prophylaxis in carefully selected thyroidectomy patients.

Conclusions:

• Routine systemic antibiotic prophylaxis does not appear to be beneficial for thyroidectomy patients younger than eighty without significant comorbidities.
• Further research with larger patient cohorts is warranted to obtain statistically significant data on antibiotic prophylaxis in thyroidectomy.
• Current findings challenge the routine use of antibiotic prophylaxis in select thyroidectomy patients, aligning with existing guideline recommendations.