Perioperative Antimicrobial Prophylaxis for Intra-abdominal Surgery in Patients with Cancer: A Retrospective Study Comparing Ertapenem and Nonertapenem Antibiotics
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To evaluate the role of ertapenem versus other standard antibiotic prophylaxis in patients with cancer undergoing intra-abdominal surgery.
Our study was a retrospective cohort study consisting 615 patients who underwent intra-abdominal surgery at our institution between January 2007 and December 2010. The groups were divided among patients who received ertapenem as perioperative prophylaxis (ertapenem group) and patients who received other antibiotics (nonertapenem group). Groups were similar with respect to age, gender, and type of surgery.
A total of 315 patients underwent colorectal and 300 noncolorectal surgeries. In a multivariate logistic regression model, the main factors associated with risk of surgical site infections (SSI) were as follows: antibiotics within 3 months of surgery (odds ratio [OR] 1.2, 95 % confidence interval [CI] 1.04–1.54; p = 0.05), prior hospitalization within 1 year (OR 1.21, 95 % CI 1.02–1.43; p = 0.05), diabetes mellitus (OR 2.1, 95 % CI 1.7–3.4; p = 0.04), and perioperative prophylaxis other than ertapenem (OR 1.7, 95 % CI 1.2–2.3; p = 0.04). Notably, patients who underwent colorectal surgery and received ertapenem had a lower rate of SSI (4 % ertapenem vs. 13 % nonertapenem, p = 0.01), whereas the frequency of infections was not different in patients who underwent other intra-abdominal surgery whether they received ertapenem or not.
The use of ertapenem for perioperative prophylaxis in patients with colorectal surgery was associated with lower rates of SSI, while there was no difference in rates of infection in other intra-abdominal surgery.
- Skarzynska J, Cienciala A, Madry R, et al. Hospital infections in general surgery wards. Przegl Epidemiol. 2000;54:299–304.
- Cruse P. Wound infection surveillance. Rev Infect Dis. 1981;3:734–7. CrossRef
- Smith RL, Bohl JK, McElearney ST, et al. Wound infection after elective colorectal resection. Ann Surg. 2004;239:599–605. CrossRef
- Ozalp N, Zulfikaroglu B, Gocmen E, et al. Risk factors for surgical site infection after gastrectomy with D2 lymphadenectomy. Surg Today. 2009;39:1013–5. CrossRef
- Velasco E, Thuler LC, Martins CA, Dias LM, Conalves VM. Risk factors for infectious complications after abdominal surgery for malignant disease. Am J Infect Control. 1996;24:1–6. CrossRef
- Hidron AI, Edwards JR, Patel J, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infect Control Hosp Epidemiol. 2008;29:996–1011. CrossRef
- Periti P, Tonelli F, Mazzei T, Ficari F. Antimicrobial chemoimmunoprophylaxis in colorectal surgery with cefotetan and thymostimulin: prospective, controlled multicenter study. Italian Study Group on Antimicrobial Prophylaxis in Abdominal Surgery. J Chemother. 1993;5:37–42.
- Skipper D, Karran SJ. A randomized prospective study to compare cefotetan with cefuroxime plus metronidazole as prophylaxis in elective colorectal surgery. J Hosp Infect. 1992;21:73–7. CrossRef
- Hershman MJ, Swift RI, Reilly DT, et al. Prospective comparative study of cefotetan with piperacillin for prophylaxis against infection in elective colorectal surgery. J R Coll Surg Edinb. 1990;35:29–32.
- Goldstein EJ, Citron DM, Merriam CV, Abramson MA. Infection after elective colorectal surgery: bacteriological analysis of failures in a randomized trial of cefotetan vs. ertapenem prophylaxis. Surg Infect (Larchmt). 2009;10:111–8. CrossRef
- Rolston KV, LeBlanc BM, Streeter H, Ho DH. In vitro activity of ertapenem against bacterial isolates from cancer patients. Diagn Microbiol Infect Dis. 2002;43:219–23. CrossRef
- Itani KM, Wilson SE, Awad SS, Jensen EH, Finn TS, Abramson MA. Ertapenem versus cefotetan prophylaxis in elective colorectal surgery. N Engl J Med. 2006;355:2640–51. CrossRef
- Livermore DM, Sefton AM, Scott GM. Properties and potential of ertapenem. J Antimicrob Chemother. 2003;52:331–44. CrossRef
- Cunha BA. Ertapenem. A review of its microbiologic, pharmacokinetic and clinical aspects. Drugs Today (Barc). 2002;38:195–213. CrossRef
- Dripps RD. Pharmacodynamics of human disease. 2. Therapeutic application of opiates. Postgrad Med. 1963;34:520–4.
- Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13:606–8. CrossRef
- Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990 s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999;20:725–30. CrossRef
- Miles AA, Miles EM, Burke J. The value and duration of defence reactions of the skin to the primary lodgement of bacteria. Br J Exp Pathol. 1957;38:79–96.
- Burke JF. The effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surgery. 1961;50:161–8.
- Nicastri E, Petrosillo N, Martini L, et al. Prevalence of nosocomial infections in 15 Italian hospitals: first point prevalance study for the INF-NOS project. Infection. 2003;31(Suppl 2):10–5.
- Garner JS. CDC guideline for prevention of surgical wound infections 1985 supersedes guideline for prevention of surgical wound infections published in 1982. (Originally published November 1985.) Revised. Infect Control. 1986;7:193–200.
- Fiorio M, Marvaso A, Vigano F, Marchetti F. Incidence of surgical site infections in general surgery in Italy. Infection. 2006;34:310–4. CrossRef
- Edwards JR, Peterson KD, Mu Y, et al. National healthcare safety network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control. 2009;37:783–805. CrossRef
- Tang R, Chen HH, Wang YL, et al. Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2,809 consecutive patients. Ann Surg. 2001;234:181–9. CrossRef
- Milsom JW, Smith DL, Corman ML, Howerton RA, Yellin AE, Luke DR. Double-blind comparison of single-dose alatrofloxacin and cefotetan as prophylaxis of infection following elective colorectal surgery. Trovafloxacin Surgical Group. Am J Surg. 1998;176(6A Suppl):46S–52S.
- Ho VP, Barie PS, Stein SL, et al. Antibiotic regimen and the timing of prophylaxis are important for reducing surgical site infection after elective abdominal colorectal surgery. Surg Infect (Larchmt). 2011;12:255–60. CrossRef
- Itani KM, Jensen EH, Finn TS, Tomassini JE, Abramson MA. Effect of body mass index and ertapenem versus cefotetan prophylaxis on surgical site infection in elective colorectal surgery. Surg Infect (Larchmt). 2008;9:131–7. CrossRef
- Eagye KJ, Nicolau DP. Selection of prophylactic antimicrobial agent may affect incidence of infection in small bowel and colorectal surgery. Surg Infect (Larchmt). 2011;12:451–7. CrossRef
- Jeong SJ, Kim CO, Han SH, et al. Risk factors for surgical site infection after gastric surgery: a multicentre case-control study. Scand J Infect Dis. In press.
- Kim ES, Kim HB, Song KH, et al. Prospective Nationwide surveillance of surgical site infections after gastric surgery and risk factor analysis in the Korean Nosocomial Infections Surveillance System (KONIS). Infect Control Hosp Epidemiol. 2012;33:572–80. CrossRef
- Nelson RL, Glenny AM, Song F. Antimicrobial prophylaxis for colorectal surgery. Cochrane Database Syst Rev. 2009;(1):CD001181.
- Hagihara M, Suwa M, Ito Y, et al. Preventing surgical-site infections after colorectal surgery. J Infect Chemother. 2012;18:83–9. CrossRef
- Lee JS, Terjimanian MN, Tishberg LM, et al. Surgical site infection and analytic morphometric assessment of body composition in patients undergoing midline laparotomy. J Am Coll Surg. 2011;213:236–44. CrossRef
- Perioperative Antimicrobial Prophylaxis for Intra-abdominal Surgery in Patients with Cancer: A Retrospective Study Comparing Ertapenem and Nonertapenem Antibiotics
Annals of Surgical Oncology
Volume 21, Issue 2 , pp 513-519
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- 1. Department of Infectious Diseases, Infection Control and Employee Health, Unit 1460, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- 2. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA