Comparing Prophylactic Administration of Sulbactam/Ampicillin Versus Cefmetazole for Prevention of Perineal Wound
Akitoshi Nankaku1,2, Shunsuke Kasai1,2, Akio Shiomi2
1Department of Gastrointestinal Surgery, Graduate School of Medicine Institute of Science Tokyo Bunkyo-ku Tokyo Japan.
Insights
A 4-day sulbactam/ampicillin (SBT/ABPC) regimen significantly reduced perineal wound infections (PWI) after abdominoperineal resection (APR) compared to a 1-day cefmetazole (CMZ) regimen. This approach offers a simpler strategy for PWI prevention in APR patients.
Area of Science:
- Surgical Oncology
- Infectious Diseases
- Pharmacology
Background:
- Perineal wound infection (PWI) is a significant complication following abdominoperineal resection (APR).
- Preventive strategies are crucial to mitigate PWI incidence.
- Antibiotic prophylaxis is a key component in PWI prevention protocols.
Purpose of the Study:
- To compare the efficacy of a 4-day sulbactam/ampicillin (SBT/ABPC) regimen versus a 1-day cefmetazole (CMZ) regimen for preventing PWI after APR.
- To evaluate secondary outcomes including surgical site infections (SSI), other complications, and hospital stay.
Main Methods:
- A multicenter, open-label, randomized controlled trial involving 80 patients undergoing APR for rectal cancer.
- Patients were randomized to receive either a 4-day SBT/ABPC regimen or a 1-day CMZ regimen.
- Primary outcome was PWI incidence; secondary outcomes included SSI, other complications, and length of hospital stay.
Main Results:
- The incidence of PWI was significantly lower in the SBT/ABPC group (10.3%) compared to the CMZ group (24.3%) (p=0.096).
- No significant differences were observed in overall SSI, other complications, or postoperative hospital stay between the groups.
- SBT/ABPC demonstrated broader bacterial coverage compared to CMZ for PWI treatment.
Conclusions:
- A 4-day SBT/ABPC regimen is more effective in reducing PWI incidence after APR than a 1-day CMZ regimen.
- This extended antibiotic regimen represents a potentially beneficial and simple approach for PWI prevention.
- Further research may explore optimal antibiotic durations and combinations for APR patients.
Aim:
Perineal wound infection (PWI) is a critical complication unique to abdominoperineal resection (APR) that requires preventive interventions. This study compared the efficacy of a 4-day regimen of sulbactam/ampicillin (SBT/ABPC) with that of a 1-day regimen of cefmetazole (CMZ) for preventing PWI after APR.
Methods:
Eighty patients who underwent APR for rectal cancer were enrolled in this multicenter, open-label, randomized controlled trial. The primary outcome was the incidence of PWI, and secondary outcomes included the incidence of surgical site infections (SSI), other complications, and length of postoperative hospital stay. Based on an assumed PWI incidence of 46% for CMZ and 14% for SBT/ABPC, a sample size of 40 participants per group was required to achieve a 90% power at a two-sided 10% significance level.
Results:
Of the 80 randomized patients, 76 were analyzed in the SBT/ABPC (n = 39) and CMZ (n = 37) groups. The incidence of PWI (10.3% vs. 24.3%, respectively; p = 0.096) was significantly lower in the SBT/ABPC group than in the CMZ group, based on a planned two-sided significance level of 10%. SSI, other complications, including antibiotic-related adverse events, and length of postoperative hospital stay, were not significantly different between the two groups. SBT/ABPC demonstrated broader bacterial coverage than CMZ in the PWI treatment.
Conclusion:
The 4-day SBT/ABPC regimen significantly reduced the incidence of PWI after APR compared to the 1-day CMZ regimen. This simple approach to antibiotic selection may be beneficial for preventing PWI.
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