Division of Gastrointestinal Surgery, Department of Surgery, Kyoto University, Kyoto, Japan.
Department of Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
Surg Infect (Larchmt). 2024 Sep;25(7):492-498. doi: 10.1089/sur.2024.020. Epub 2024 Jul 8.
Recently, antimicrobial resistance has received considerable attention. Broad-spectrum antimicrobial agents are recommended as the initial therapy for post-operative intra-abdominal infections. However, at our institution, we have adopted a tactic of initially treating post-operative intra-abdominal complications with relatively narrow-spectrum antimicrobial agents, such as second-generation cephalosporins. In the present study, we aimed to retrospectively analyze the use of antimicrobial agents and the resulting treatment outcomes in patients with intra-abdominal complications after gastrectomy at our facility. We conducted a retrospective observational study of patients treated with antibiotic agents for intra-abdominal infectious complications after gastrectomy between 2011 and 2021. We determined the proportion of "initial treatment failures" associated with the initial administration of antibiotic agents for post-operative intra-abdominal complications. Post-operative intra-abdominal infections were observed in 29 patients. Broad-spectrum antimicrobial agents were not administered. We successfully treated 19 patients. Initial treatment failure was observed in 10 patients, of whom five experienced failure due to bacterial resistance to the initial antimicrobial agent. All 10 patients who experienced initial treatment failure were discharged after drainage procedures or other treatments. There were no deaths due to post-operative complications. Cefmetazole was used as the initial antimicrobial agent in 27 of the 29 patients. Considering that all patients with post-gastrectomy intra-abdominal infections were successfully treated using relatively narrow-spectrum antimicrobial agents, and initial treatment failure due to antimicrobial-resistant pathogens was 17.2%, the use of narrow-range antimicrobial agents for intra-abdominal infections after gastrectomy can be deemed appropriate.
最近，抗菌药物耐药性受到了相当多的关注。广谱抗菌药物被推荐作为术后腹腔内感染的初始治疗药物。然而，在我们的机构，我们采取了一种策略，即最初使用相对窄谱的抗菌药物治疗术后腹腔内并发症，如第二代头孢菌素。在本研究中，我们旨在回顾性分析我们机构胃切除术后腹腔内并发症患者使用抗菌药物和治疗结果。
我们对 2011 年至 2021 年期间因胃切除术后腹腔内感染性并发症接受抗生素治疗的患者进行了回顾性观察性研究。我们确定了与术后腹腔内并发症初始使用抗生素治疗相关的“初始治疗失败”的比例。
29 例患者发生术后腹腔内感染。未给予广谱抗菌药物。我们成功治疗了 19 例患者。10 例患者出现初始治疗失败，其中 5 例因初始抗菌药物对细菌耐药而失败。所有 10 例初始治疗失败的患者均在引流或其他治疗后出院。无术后并发症死亡病例。在 29 例患者中，有 27 例患者使用头孢美唑作为初始抗菌药物。
考虑到所有胃切除术后腹腔内感染患者均成功使用相对窄谱抗菌药物治疗，且因抗菌药物耐药病原体导致的初始治疗失败率为 17.2%，因此，胃切除术后腹腔内感染使用窄谱抗菌药物是合理的。
