Righi M, Manfredi R, Farneti G, Pasquini E, Cenacchi V
Istituto di Clinica Otorinolaringologica, Università di Bologna, Italy.
Head Neck. 1996 Sep-Oct;18(5):399-404. doi: 10.1002/(SICI)1097-0347(199609/10)18:5<399::AID-HED2>3.0.CO;2-0.
Although antimicrobial prophylaxis is mandatory in major clean-contaminated oncologic surgery of the head and neck, both the choice of specific antimicrobial compounds and the treatment duration are still discussed.
A prospective, randomized trial was carried out to compare efficacy and tolerability of clindamycin-cefonicid administered for 1 day versus 3 days in reducing the rate of wound and systemic infections. The following potential risk factors for surgical wound infection were evaluated: type of surgery, stage of disease, preoperative tracheostomy, preoperative radiotherapy, and diabetes mellitus.
One-hundred sixty-two patients were evaluable; 81 received 1-day chemoprophylaxis, while the remaining 81 were treated according to the 3-day schedule. During the first 20 days after surgery, wound infections occurred in 2 (2.5%) and 3(3.7%) patients, respectively, in the 1-day and 3-day treatment groups, so that no significant difference was found among the two evaluated chemoprophylaxis schedules.
A 3-day schedule did not prove useful in preventing wound and systemic infections. All presumed risk factors were not associated with an increased rate of wound infections, although preoperative radiotherapy was associated with a greater severity of infections and a higher risk of late wound complications.
尽管在头颈部重大清洁-污染性肿瘤手术中抗菌药物预防是必需的，但具体抗菌化合物的选择和治疗持续时间仍存在争议。
开展一项前瞻性随机试验，比较克林霉素-头孢尼西使用1天与3天在降低伤口感染和全身感染发生率方面的疗效和耐受性。评估了以下手术伤口感染的潜在危险因素：手术类型、疾病分期、术前气管切开术、术前放疗和糖尿病。
162例患者可进行评估；81例接受1天的化学预防，其余81例按照3天方案治疗。在术后的前20天内，1天治疗组和3天治疗组分别有2例（2.5%）和3例（3.7%）患者发生伤口感染，因此在两种评估的化学预防方案之间未发现显著差异。
3天方案在预防伤口感染和全身感染方面未被证明有效。所有假定的危险因素均与伤口感染率增加无关，尽管术前放疗与感染的严重程度增加和晚期伤口并发症的风险较高有关。
