Li Baojian
Department of Pharmacy, Heping Hospital Affiliated to Changzhi Medical College, Changzhi 046000, Shanxi, China.
J Healthc Eng. 2022 Apr 11;2022:6203817. doi: 10.1155/2022/6203817. eCollection 2022.
According to recent reports, prophylactic use of antibiotics is not always required in conventional transarterial chemoembolization (c-TACE). However, clinical evidence of prophylactic antibiotics in drug-eluting beads transarterial chemoembolization (DEB-TACE) to prevent postsurgical infection is limited. This study is aimed to evaluate the correlation between the preoperative prophylactic application of antibiotics and postoperative infection in c-TACE or DEB-TACE, especially in a population with a high risk for postsurgical infection.
In this retrospective study, TACE patients diagnosed with hepatic carcinoma (between January 2019 and May 2021) were examined. The case group was given 1.5 g cefuroxime sodium 0.5-1 hour before TACE, while there was no intervention in the control group. The outcomes analyzed were leukocyte count >9.5 × 10/L on the second day after the operation and the diagnosis of infection within one month after the operation. We applied univariate, multivariate logistic regression, trend analysis, and subgroup analysis to find potential risk factors and the necessity of prophylactic antibiotics.
Among 142 eligible cases, 72 received antibiotics while 70 were kept as control, 113 cases were treated with c-TACE, and 29 were treated with DEB-TACE. Multivariate analysis showed that the increase in white blood cell count after the operation was related to diabetes (OR 5.112, 95% CI 1.229-21.264, = 0.025). The occurrence of postoperative infection was negatively correlated with preoperative albumin value (＜25 g/L) (OR 153.118, 95% CI 1.631-14372.331, = 0.030). Trend analysis showed that the risk of postoperative infection increased with a decrease in serum albumin level ( < 0.05). Subgroup analysis showed that there were no significant differences in the incidence of increased leukocyte count and postoperative infection between the prophylactic and nonprophylactic treatment groups, in the case of diabetes, preoperative albumin levels, and operation mode ( > 0.1).
Prophylactic antibiotic treatment before the c-TACE or DEB-TACE had no significant correlation with postoperative leukocyte increase and postoperative infection. Diabetes history and serum albumin levels were the prominent risk factors associated with an increase in postoperative leukocyte count and postoperative infection. Future large-scale studies and randomized-controlled trials are required to confirm and validate this association.
根据最近的报告，传统经动脉化疗栓塞术（c-TACE）并不总是需要预防性使用抗生素。然而，药物洗脱微球经动脉化疗栓塞术（DEB-TACE）中预防性使用抗生素以预防术后感染的临床证据有限。本研究旨在评估c-TACE或DEB-TACE术前预防性应用抗生素与术后感染之间的相关性，尤其是在术后感染高风险人群中。
在这项回顾性研究中，对2019年1月至2021年5月期间诊断为肝癌的TACE患者进行了检查。病例组在TACE术前0.5 - 1小时给予1.5g头孢呋辛钠，而对照组未进行干预。分析的结果包括术后第二天白细胞计数>9.5×10⁹/L以及术后1个月内的感染诊断。我们应用单因素、多因素逻辑回归、趋势分析和亚组分析来寻找潜在风险因素以及预防性使用抗生素的必要性。
在142例符合条件的病例中，72例接受了抗生素治疗而70例作为对照，113例接受c-TACE治疗，29例接受DEB-TACE治疗。多因素分析表明，术后白细胞计数增加与糖尿病有关（OR 5.112，95%CI 1.229 - 21.264，P = 0.025）。术后感染的发生与术前白蛋白值（＜25g/L）呈负相关（OR 153.118，95%CI 1.631 - 14372.331，P = 0.030）。趋势分析表明，术后感染风险随着血清白蛋白水平的降低而增加（P＜0.05）。亚组分析表明，在糖尿病、术前白蛋白水平和手术方式方面，预防性治疗组与非预防性治疗组之间白细胞计数增加和术后感染的发生率无显著差异（P＞0.1）。
c-TACE或DEB-TACE术前预防性抗生素治疗与术后白细胞增加和术后感染无显著相关性。糖尿病史和血清白蛋白水平是与术后白细胞计数增加和术后感染相关的突出风险因素。未来需要大规模研究和随机对照试验来证实和验证这种关联。
