Ning Dong, Zhou Lin, Shi Guidong, Fu Maoyong
Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China.
Department of Ultrasound, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China.
Int J Gen Med. 2025 Aug 5;18:4267-4277. doi: 10.2147/IJGM.S513707. eCollection 2025.
To verify the hypothesis that "the prophylaxis use time of antibiotics after esophageal cancer (EC) surgery ≤24 hours is associated with a lower postoperative infection rate and improvement of nutritional indicators", a retrospective cohort analysis was conducted to compare the infection incidence and differences in serum nutritional indicators among patients with different medication durations (< 24 hours, 24-48 hours, > 48 hours), and to identify independent risk factors for postoperative infection.
A retrospective analysis was conducted on the data of 566 patients who underwent EC surgery in Affiliated Hospital of North Sichuan Medical College from January 2020 to October 2022. Patients were divided into three groups based on the duration of postoperative antibiotic prophylaxis: Group A (<24 hours), Group B (24-48 hours), and Group C (>48 hours). The differences in postoperative infection incidence and nutritional indicators [serum albumin (ALB), prealbumin (PA), hemoglobin (Hb) levels] among the three groups of patients were compared. Multivariate logistic regression analysis was performed to analyze the risk factors.
There existed a significant difference in the nutritional indicators among the patients in the three groups after surgery (<0.05). On day 10 after surgery, the ALB, PA, and Hb levels of patients in group A were much higher than those in group B and group C (<0.05). There was no significant difference in the levels of ALB, PA, and Hb between Group B and Group C (>0.05). The infected group had a much higher proportion of patients with age ≥ 65 years, moderate pulmonary ventilation impairment, intraoperative blood loss ≥ 200mL, postoperative respiratory support with a tube, hospitalization days ≥ 25 days, and malnutrition than the uninfected group (<0.05). Age, lung ventilation, hospitalization days, and preoperative malnutrition were all risk factors for postoperative infection in EC patients (<0.05).
This study verified the hypothesis that "antibiotic use time ≤24 hours is associated with a lower infection rate trend and an increase in nutritional indicators", but the causal relationship could not be established due to the retrospective design. Age, pulmonary ventilation function, length of hospital stay, and preoperative malnutrition were independent risk factors for postoperative infection, supporting the clinical formulation of individualized antibiotic regimens based on the association between medication duration and infection/nutrition.
为验证“食管癌（EC）手术后抗生素预防性使用时间≤24小时与术后感染率降低及营养指标改善相关”这一假设，进行一项回顾性队列分析，比较不同用药时长（<24小时、24 - 48小时、>48小时）患者的感染发生率及血清营养指标差异，并确定术后感染的独立危险因素。
对2020年1月至2022年10月在川北医学院附属医院接受EC手术的566例患者的数据进行回顾性分析。根据术后抗生素预防性使用时长将患者分为三组：A组（<24小时）、B组（24 - 48小时）和C组（>48小时）。比较三组患者术后感染发生率及营养指标[血清白蛋白（ALB）、前白蛋白（PA）、血红蛋白（Hb）水平]的差异。进行多因素logistic回归分析以分析危险因素。
三组患者术后营养指标存在显著差异（<0.05）。术后第10天，A组患者的ALB、PA和Hb水平显著高于B组和C组（<0.05）。B组和C组之间的ALB、PA和Hb水平无显著差异（>0.05）。感染组患者中年龄≥65岁、中度肺通气功能障碍、术中失血≥200mL、术后气管插管呼吸支持、住院天数≥25天及营养不良的比例均高于未感染组（<0.05）。年龄、肺通气功能、住院天数及术前营养不良均为EC患者术后感染的危险因素（<0.05）。
本研究验证了“抗生素使用时间≤24小时与较低的感染率趋势及营养指标升高相关”这一假设，但由于回顾性设计无法建立因果关系。年龄、肺通气功能、住院时长及术前营养不良是术后感染的独立危险因素，支持基于用药时长与感染/营养之间关联制定个体化抗生素方案的临床决策。
