Nøhr M, Andersen J C, Juul-Jensen K E
Department of Surgical Gastroenterology A, Aalborg Sygehus Syd, Denmark.
Acta Chir Scand. 1990 Mar;156(3):223-30.
Two antibiotic regimens for the prophylaxis of infection after colorectal operations were compared in a prospective, double blind, randomised controlled trial in 244 patients. Ninety-five patients (39%) were either excluded before randomisation or withdrawn, leaving 149 for analysis. Group 1 (n = 72) received a single infusion of 8 g fosfomycin and 1 g metronidazole at the induction of anaesthesia. Group 2 (n = 77) received bacitracin 250 mg plus neomycin 250 mg (as four tablets on three occasions over two days), metronidazole 500 mg tablets three times a day for one day, and ampicillin 1 g intravenously at induction of anaesthesia. Nine patients in group 1 (13%), 95% confidence interval (CI) 6.9 to 22.4, developed infective complications, compared with 8 in group 2 (10%), 95% CI 4.6 to 19.4. The overall infection rate was 17 of 149 evaluable patients (11%), 95% CI 6.8 to 17.7. Seven patients died (five in group 1 and 2 in group 2), two of whom (one in each group) died as a direct result of infective complications. Long operations and obesity were the most important risk factors, and may indicate a need for longer prophylaxis. Fosfomycin, which is mainly active against aerobic bacteria, was both safe and useful when combined with metronidazole.
在一项针对244例患者的前瞻性、双盲、随机对照试验中，对两种用于预防结直肠手术后感染的抗生素方案进行了比较。95例患者（39%）在随机分组前被排除或退出，剩余149例用于分析。第1组（n = 72）在麻醉诱导时接受8克磷霉素和1克甲硝唑单次输注。第2组（n = 77）接受杆菌肽250毫克加新霉素250毫克（分三天，每次四片），甲硝唑500毫克片剂，每日三次，共一天，以及在麻醉诱导时静脉注射氨苄西林1克。第1组有9例患者（13%），95%置信区间（CI）为6.9至22.4，发生感染性并发症，而第2组有8例（10%），95%CI为4.6至19.4。在149例可评估患者中，总体感染率为17例（11%），95%CI为6.8至17.7。7例患者死亡（第1组5例，第2组2例），其中2例（每组各1例）直接死于感染性并发症。手术时间长和肥胖是最重要的危险因素，可能表明需要更长时间的预防。主要对需氧菌有活性的磷霉素与甲硝唑联合使用既安全又有效。
