Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
Infection. 2018 Oct;46(5):617-624. doi: 10.1007/s15010-018-1160-2. Epub 2018 Jun 5.
Thoracoabdominal esophageal resection for malignant disease is frequently associated with pulmonary infection. Whether prolonged antibiotic prophylaxis beyond a single perioperative dose is advantageous in preventing pulmonary infection after thoracoabdominal esophagectomy remains unclear.
In this retrospective before-and-after analysis, 173 patients between January 2009 and December 2014 from a prospectively maintained database were included. We evaluated the effect of a 5-day postoperative course of moxifloxacin, which is a frequently used antimicrobial agent for pneumonia, on the incidence of pulmonary infection and mortality after thoracoabdominal esophagectomy.
104 patients received only perioperative antimicrobial prophylaxis (control group) and 69 additionally received a 5-day postoperative antibiotic therapy with moxifloxacin (prolonged-course). 22 (12.7%) of all patients developed pneumonia within the first 30 days after surgery. No statistically significant differences were seen between the prolonged group and control group in terms of pneumonia after 7 (p = 0.169) or 30 days (p = 0.133), detected bacterial species (all p > 0.291) and 30-day mortality (5.8 vs 10.6%, p = 0.274).
A preemptive 5-day postoperative course of moxifloxacin does not reduce the incidence of pulmonary infection and does not improve mortality after thoracoabdominal esophagectomy.
胸腹部食管切除术治疗恶性疾病常伴有肺部感染。在胸腹部食管切除术后，多剂量预防性使用抗生素是否优于单次围手术期剂量以预防肺部感染尚不清楚。
在这项回顾性前后对照分析中，我们纳入了 2009 年 1 月至 2014 年 12 月期间从一个前瞻性维护的数据库中选择的 173 例患者。我们评估了术后使用莫西沙星（一种常用于肺炎治疗的抗菌药物）5 天疗程对胸腹部食管切除术后肺部感染和死亡率的影响。
104 例患者仅接受围手术期抗菌预防（对照组），69 例患者另外接受莫西沙星 5 天术后抗生素治疗（延长疗程组）。所有患者中有 22 例（12.7%）在术后 30 天内发生肺炎。在术后 7 天（p=0.169）或 30 天（p=0.133）时，延长疗程组和对照组之间在肺炎发生率、检测到的细菌种类（均 p>0.291）和 30 天死亡率（5.8% vs. 10.6%，p=0.274）方面无统计学差异。
预防性使用莫西沙星 5 天术后疗程并不能降低胸腹部食管切除术后肺部感染的发生率，也不能改善 30 天死亡率。
