Bold R J, Mansfield P F, Berger D H, Pollock R E, Singletary S E, Ames F C, Balch C M, Hohn D C, Ross M I
Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Am J Surg. 1998 Sep;176(3):239-43. doi: 10.1016/s0002-9610(98)00154-8.
Antibiotic prophylaxis is controversial in patients undergoing axillary lymph node dissection (ALND). We determined whether preoperative antibiotics decreased incidence or treatment cost of infectious complications following ALND.
Two hundred patients entered this prospective, randomized, double-blind trial. Patients received either placebo or cefonicid preoperatively. Loco-regional signs of infection were monitored for 4 weeks postoperatively.
There was a trend toward fewer infections in the prophylactic group (placebo 13% versus cefonicid 6%; P = 0.080). Cefonicid significantly decreased severe infections requiring hospitalization (placebo 8% versus cefonicid 1%; P = 0.033). Cefonicid also decreased the treatment cost of infection per patient ($49.80 versus $364.87).
We demonstrated a trend toward fewer overall infections and significantly fewer severe infections in patients given prophylactic antibiotics, which translated into a decrease in the cost of treatment for infectious complications. These findings support antibiotic prophylaxis for patients undergoing ALND.
抗生素预防在接受腋窝淋巴结清扫术（ALND）的患者中存在争议。我们确定术前使用抗生素是否会降低ALND后感染并发症的发生率或治疗成本。
200名患者进入这项前瞻性、随机、双盲试验。患者术前接受安慰剂或头孢尼西治疗。术后4周监测局部感染体征。
预防组感染趋势较少（安慰剂组13%，头孢尼西组6%；P = 0.080）。头孢尼西显著降低了需要住院治疗的严重感染发生率（安慰剂组8%，头孢尼西组1%；P = 0.033）。头孢尼西还降低了每位患者的感染治疗成本（49.80美元对364.87美元）。
我们证明了接受预防性抗生素治疗的患者总体感染趋势较少，严重感染显著减少，这转化为感染并发症治疗成本的降低。这些发现支持对接受ALND的患者进行抗生素预防。
