Rowe-Jones D C, Peel A L, Kingston R D, Shaw J F, Teasdale C, Cole D S
Poole General Hospital, Poole, Dorset.
BMJ. 1990 Jan 6;300(6716):18-22. doi: 10.1136/bmj.300.6716.18.
To establish whether a single preoperative dose of cefotaxime plus metronidazole was as effective as a standard three dose regimen of cefuroxime plus metronidazole in preventing wound infection after colorectal surgery.
Prospective randomised allocation to one of two prophylactic antibiotic regimens in a parallel group trial. Group sequential analyses of each 250 patients were performed.
14 District general and teaching hospitals.
1018 Adults having colorectal operations were randomised, of whom 943 were evaluated. Demographic features, conditions requiring surgery, and operative procedures were similar in the two groups. Most patients had surgery for carcinoma of the colon or rectum.
Group 1 received cefotaxime 1 g intravenously plus metronidazole 500 mg intravenously preoperatively. Group 2 received cefuroxime 1.5 g intravenously plus metronidazole 500 mg intravenously preoperatively, followed by cefuroxime 750 mg intravenously plus metronidazole 500 mg intravenously eight hours and 16 hours postoperatively.
Development of surgical wound infection (as evidenced by the presence of pus), death, or discharge from hospital.
Wound condition was scored on a five point scale on alternate days until discharge or for up to 20 days postoperatively. Wound infection rates were: group 1, 32/453 (7.1%; 95% confidence interval 4.7% to 9.4%); group 2, 33/454 (7.3%; 95% confidence interval 4.9% to 9.6%). Death rates (group 1: 26/470 (5.5%); group 2: 31/471 (6.6%], the incidence of postoperative complications, the median duration of hospital stay (12 days), and antibiotic tolerance were all similar in the two groups. Pooled data from groups 1 and 2 showed that wound infections were more frequent when minor faecal contamination had occurred at operation and when the duration of operation exceeded 90 minutes (greater than 90 min 11.2% of cases; less than 90 min 4.8%) and were associated with an extended hospital stay.
A single preoperative dose of cefotaxime plus metronidazole is an efficacious as a three dose regimen of cefuroxime plus metronidazole in preventing wound infection after colorectal surgery and has practical advantages in eliminating the need for postoperative antibiotics.
确定结直肠手术后，术前单次使用头孢噻肟加甲硝唑预防伤口感染的效果是否与标准的头孢呋辛加甲硝唑三剂方案相同。
在平行组试验中对两种预防性抗生素方案之一进行前瞻性随机分配。对每250名患者进行组序分析。
14家地区综合医院和教学医院。
1018例接受结直肠手术的成人被随机分组，其中943例接受评估。两组患者的人口统计学特征、需要手术的病情及手术操作相似。大多数患者因结肠癌或直肠癌接受手术。
第1组术前静脉注射1g头孢噻肟加500mg甲硝唑。第2组术前静脉注射1.5g头孢呋辛加500mg甲硝唑，术后8小时和16小时再分别静脉注射750mg头孢呋辛加500mg甲硝唑。
手术伤口感染（有脓液证明）情况、死亡情况或出院情况。
直至出院或术后20天内，每隔一天对伤口情况按五分制进行评分。伤口感染率为：第1组，32/453（7.1%；95%置信区间4.7%至9.4%）；第2组，33/454（7.3%；95%置信区间4.9%至9.6%）。两组的死亡率（第1组：26/470（5.5%）；第2组：31/471（6.6%））、术后并发症发生率、中位住院时间（12天）及抗生素耐受性均相似。第1组和第2组合并数据显示，手术时出现轻度粪便污染以及手术时间超过90分钟时伤口感染更常见（手术时间大于90分钟的病例为11.2%；小于90分钟的为4.8%），且与住院时间延长有关。
结直肠手术后，术前单次使用头孢噻肟加甲硝唑预防伤口感染的效果与头孢呋辛加甲硝唑三剂方案相同，且在无需术后使用抗生素方面具有实际优势。
