Uchiyama Kazuhisa, Takifuji Katsunari, Tani Masqji, Ueno Masaki, Kawai Manabu, Ozawa Satoru, Yamaue Hiroki
Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
Hepatogastroenterology. 2007 Jul-Aug;54(77):1487-93.
BACKGROUND/AIMS: This study was conducted to judge the effect of intravenous administration of antimicrobial agents immediately before surgery for patients with gastrointestinal cancers to prevent postoperative surgical site infections (SSIs) and remote site infections.
A total of 3437 patients with gastrointestinal cancers underwent standby operations in Wakayama Medical University Hospital between 1987 and 2002. Of these, 1483 were treated between 1987 and 1995, and intravenous antimicrobial agents were used only postoperatively for 2 to 5 days (no AMP group). In addition to the postoperative administration, antimicrobial agents were injected immediately before surgery in 1954 patients (AMP group). If the operation continues more than 3 hours, antimicrobial agents were injected every 3 hours during operation. A comparison was made between the no AMP group and AMP group concerning the bacteria detected and the incidence of SSIs and remote site infections.
The incidence of superficial or deep incisional SSI after surgery was higher in esophageal cancer (17.2%) throughout the whole period than in gastric cancer (4.2%), colon cancer (5.2%) and hepatic/biliary/pancreatic cancers (4.9%) (p < 0.00001). On the other hand, the incidence of space/organ SSI after surgery was higher in hepatic/biliary/pancreatic cancers (14.7%) than esophageal cancer (8.4%; p = 0.02), gastric cancer (7.9%), and colon cancer (8.1%; p < 0.00001). The overall incidence of superficial or deep incisional SSI after surgery for gastrointestinal cancers was 7.2% in the no AMP group, and 4.1% in the AMP group (p = 0.00006). However, in the overall incidence of space/organ SSI, no significant difference was observed between the no AMP group (10.3%) and the AMP group (8.8%). In addition, the incidence of remote site infections also showed no significant difference between the two groups. Regarding bacterial isolates detected after surgery, the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) decreased from 10.8% to 6.2% among the bacterial strains detected (p = 0.00009), and Pseudomonas sp. also decreased from 13.5% to 10.2% (p = 0.002), but Enterococcus sp. increased from 12.1% to 20.4% (p < 0.00001).
Preoperative AMP was useful to suppress postoperative superficial or deep incisional SSI, but was unlikely to suppress organ/space SSI or remote site infections. In addition, due to preoperative AMP, MRSA and Pseudomonas sp., which showed SSIs, were decreased in detection rates, whereas the detection rate of Enterococcus sp., which is resistant to cephems, was increased.
背景/目的：本研究旨在判断胃肠道癌患者术前即刻静脉注射抗菌药物对预防术后手术部位感染（SSIs）和远隔部位感染的效果。
1987年至2002年间，共有3437例胃肠道癌患者在和歌山县立医科大学医院接受择期手术。其中，1483例在1987年至1995年间接受治疗，术后仅使用静脉抗菌药物2至5天（无抗菌药物组）。另外1954例患者（抗菌药物组）除术后给药外，术前即刻注射抗菌药物。若手术持续超过3小时，则术中每3小时注射抗菌药物。比较无抗菌药物组和抗菌药物组之间检测到的细菌以及SSIs和远隔部位感染的发生率。
整个时期内，食管癌术后浅表或深部切口SSI的发生率（17.2%）高于胃癌（4.2%）、结肠癌（5.2%）和肝/胆/胰腺癌（4.9%）（p<0.00001）。另一方面，肝/胆/胰腺癌术后腔隙/器官SSI的发生率（14.7%）高于食管癌（8.4%；p=0.02）、胃癌（7.9%）和结肠癌（8.1%；p<0.00001）。胃肠道癌术后浅表或深部切口SSI的总体发生率在无抗菌药物组为7.2%，在抗菌药物组为4.1%（p=0.00006）。然而，在腔隙/器官SSI的总体发生率方面，无抗菌药物组（10.3%）和抗菌药物组（8.8%）之间未观察到显著差异。此外，两组之间远隔部位感染的发生率也无显著差异。关于术后检测到的细菌分离株，耐甲氧西林金黄色葡萄球菌（MRSA）在检测到的菌株中的患病率从10.8%降至6.2%（p=0.00009），假单胞菌属也从13.5%降至10.2%（p=0.002），但肠球菌属从12.1%增至20.4%（p<0.00001）。
术前使用抗菌药物有助于抑制术后浅表或深部切口SSI，但不太可能抑制器官/腔隙SSI或远隔部位感染。此外，由于术前使用抗菌药物，显示为SSIs的MRSA和假单胞菌属的检出率降低，而对头孢菌素耐药的肠球菌属的检出率增加。
