Published in:
01-01-2015 | Original Article
Optimal duration of prophylactic antimicrobial administration and risk of postoperative infectious events in thoracic esophagectomy with three-field lymph node dissection: short-course versus prolonged antimicrobial administration
Published in: Esophagus | Issue 1/2015
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Background
For prevention of surgical site infections, the current guidelines of Center of Disease Control recommend the maintenance of therapeutic levels of prophylactic antimicrobial agents throughout operations and, at most, for a few hours after incision closure. However, in literature supporting these recommendations, most reports have described combinations of various types of surgical procedures. Consequently, the optimal duration of prophylactic antimicrobial administration in esophagectomy with three-field lymph node dissection has not been fully addressed.
Methods
We randomly assigned 257 patients with esophageal cancer who underwent esophagectomy with three-field lymph node dissection into two groups and analyzed the incidences of surgical site and remote infections. Antimicrobial administration began 30 min before the skin incision was made and repeated every 3 h during the procedure in the short-course administration group, whereas additional administration was postoperatively continued the day after operation in the prolonged administration group.
Results
Among the 128/129 patients in the short-course/prolonged administration group, surgical site infections occurred in 26.5 %/24.0 % (p = 0.64), anastomotic leakage in 11.7 %/15.5 % (p = 0.37), and incisional surgical site infections in 14.8 %/8.5 % patients, respectively (p = 0.11). Remote infections occurred in 11.7 %/11.6 % (p = 0.86) patients, respectively, and the median postoperative hospital stay was 14 days (p = 0.86) in both groups.
Conclusions
In esophagectomy with three-field lymph node dissection, short-course antimicrobial administration was sufficient for the prevention of postoperative infectious events.