[Antibiotic prevention in gastroduodenal surgery]

Area of Science:

• Surgical Infection Prevention
• Clinical Trials
• Gastrointestinal Surgery

Background:

• Antibiotic prophylaxis is crucial in preventing surgical site infections (SSIs) after gastrointestinal surgery.
• Current prophylaxis strategies vary, necessitating evaluation of their efficacy and patient selection criteria.

Purpose of the Study:

• To compare the effectiveness of three antibiotic prophylaxis strategies: systematic, selective based on gastric pH, and postoperative antibiotic therapy.
• To determine the optimal approach for reducing SSIs in elective gastrointestinal surgery.

Main Methods:

• A prospective, randomized, double-blind clinical trial involving 179 patients undergoing elective gastrointestinal surgery.
• Comparison of systematic prophylaxis (48h cefuroxime), selective prophylaxis (based on gastric pH), and postoperative antibiotic therapy.
• Infection rates were monitored and compared across all groups, including a control group.

Main Results:

• Postoperative infection rates were significantly lower in systematic (2%) and selective prophylaxis (4%) groups compared to antibiotic therapy (24%) and control (17.2%) groups (p < 0.001).
• No statistically significant difference in infection rates was observed between systematic and selective prophylaxis groups (p = NS).
• Selective prophylaxis, guided by gastric pH, demonstrated comparable efficacy to systematic prophylaxis.

Conclusions:

• Selective antibiotic prophylaxis, when guided by preoperative gastric pH, is a viable alternative to systematic prophylaxis for preventing SSIs in specific patient populations (e.g., those with bacterogastria).
• Postoperative antibiotic therapy is not an effective method for preventing postoperative infections and should be discontinued for this purpose.