Klein Alexander, Chudamani Chataut, Wieser Andreas, Goller Sophia S, Berclaz Luc M, Di Gioia Dorit, Holzapfel Boris M, Dürr Hans Roland
Orthopaedic Oncology, Department of Orthopaedics and Trauma Surgery, Ludwig-Maximilian-University (LMU) University Hospital, Ludwig-Maximilian-University (LMU) Munich, Munich, Germany.
Division of Infectious Diseases and Tropical Medicine, Ludwig-Maximilian-University (LMU) University Hospital, Ludwig-Maximilian-University (LMU) Munich, Munich, Germany.
Front Oncol. 2024 Oct 18;14:1467694. doi: 10.3389/fonc.2024.1467694. eCollection 2024.
Surgical site infections (SSI) are one of the most common complications after extensive sarcoma resections and represent a daily challenge. SSI occur in up to 50% of cases particularly in the peripelvic area. One possible approach to reduce infection rate is perioperative antibiotic prophylaxis. The aim of this study therefore was to investigate the influence of perioperative antibiotic prophylaxis on the infection rate and the possible influence of location-specific antibiotic prophylaxis with ampicillin/sulbactam.
This monocentric retrospective study included 366 patients who underwent sarcoma resections in the groin, proximal thigh, or gluteal region. All patients were operated on by 2 surgeons after neoadjuvant pretreatment if necessary. 3 groups of patients were defined. Group 1: In 60.4% of all cases, antibiotic prophylaxis was administered with cephalosporins (also clindamycin in case of penicillin allergy). Group2: In 9.8% of cases, ampicillin/sulbactam was used. Group 3: 29.8% of patients did not receive any antibiotic prophylaxis.
In 31.1% of treated cases, antibiotic therapy was prolonged due to extended tumor resections. Postoperative infections occurred in 23.2% (85 cases), in 77 cases within the first 90 days (on average after 20 days). The median operating time, blood loss was higher, and tumor size were significantly larger in cases with infections, compared to patients without infection. In group 1 and 2 with perioperative single-shot prophylaxis, infection occurred in 24.1% of cases, compared to 13.5% of cases without prophylaxis (group 3) (p= 0.032). In the patients with prolonged antibiotic therapy, infection occurred in 31.6% of cases, compared to 16.3% of cases without prolongation (p< 0.001). In the group 2, infection occurred in 19.4% of cases compared to 24.9% of cases in the group 1 (p= 0.479). In the multivariate analysis, surgery time longer 80 min, blood substitution, neoadjuvant radio- and chemotherapy proved to be a risk factor for SSI.
Region adapted perioperative antibiotic prophylaxis may reduce the risk of infection after extended sarcoma resection in the peripelvic area. However, the particular bacterial spectrum of this anatomic region should be taken into account when deciding which antibiotics to use.
手术部位感染（SSI）是广泛的肉瘤切除术后最常见的并发症之一，也是日常面临的挑战。SSI发生率高达50%，尤其在盆腔周围区域。降低感染率的一种可能方法是围手术期抗生素预防。因此，本研究的目的是调查围手术期抗生素预防对感染率的影响以及氨苄西林/舒巴坦进行部位特异性抗生素预防的可能影响。
这项单中心回顾性研究纳入了366例在腹股沟、大腿近端或臀区接受肉瘤切除术的患者。如有必要，所有患者在新辅助预处理后由2名外科医生进行手术。定义了3组患者。第1组：在所有病例的60.4%中，使用头孢菌素进行抗生素预防（对青霉素过敏者使用克林霉素）。第2组：在9.8%的病例中，使用氨苄西林/舒巴坦。第3组：29.8%的患者未接受任何抗生素预防。
在31.1%的治疗病例中，由于肿瘤切除范围扩大，抗生素治疗时间延长。术后感染发生在23.2%（85例），其中77例在术后90天内（平均20天后）。与未感染患者相比，感染患者的中位手术时间、失血量更高，肿瘤大小也明显更大。在接受围手术期单次预防的第1组和第2组中，24.1%的病例发生感染，而未接受预防的第3组为13.5%（p = 0.032）。在抗生素治疗时间延长的患者中，31.6%的病例发生感染，而未延长治疗时间的患者为16.3%（p < 0.001）。第2组中19.4%的病例发生感染，第1组为24.9%（p = 0.479）。在多变量分析中，手术时间超过80分钟、输血、新辅助放疗和化疗被证明是SSI的危险因素。
根据部位调整围手术期抗生素预防措施可能会降低盆腔周围区域广泛肉瘤切除术后的感染风险。然而，在决定使用哪种抗生素时，应考虑该解剖区域特定的细菌谱。
