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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

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Abstract

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.

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Acknowledgments

We greatly appreciate the critical discussion of our manuscript provided by members of the Division of Esophageal Surgery. We also appreciate the review and discussion of the study provided by members of the Division of Gastrointestinal Oncology.

Ethical Statement

Our work conforms to the guidelines set forth in the Helsinki Declaration of 1975, as revised in 2000, concerning Human and Animal Rights, and that we followed the policy concerning Informed Consent.

Conflict of Interest

Takeo Fujita and Hiroyuki Daiko declare that they have no conflict of interest.

Human rights statement and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Division of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-0882, Japan

    Takeo Fujita & Hiroyuki Daiko

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  1. Takeo Fujita
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  2. Hiroyuki Daiko
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Correspondence to Takeo Fujita.

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Fujita, T., Daiko, H. 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. Esophagus 12, 38–43 (2015). https://doi.org/10.1007/s10388-014-0451-7

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  • DOI: https://doi.org/10.1007/s10388-014-0451-7

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