Extended Post-Operative Antibiotics

Extended Post-Operative Antibiotics

PEP Topic 
Prevention of Infection: General
Description 

The provision of antibiotics for days after surgery, in addition to intraoperative administration of antibiotics, was examined in patients with cancer for effectiveness in the prevention of surgical site infection.

Effectiveness Unlikely

Research Evidence Summaries

Haga, N., Ishida, H., Ishiguro, T., Kumamoto, K., Ishibashi, K., Tsuji, Y., & Miyazaki, T. (2012). A prospective randomized study to assess the optimal duration of intravenous antimicrobial prophylaxis in elective gastric cancer surgery. International Surgery, 97, 169–176.

doi: 10.9738/CC91.1
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Study Purpose:

To detect an 8% difference in surgical site infections between patients receiving single- or multiple-dose antibiotics with gastric surgery

Intervention Characteristics/Basic Study Process:

All patients received IV cefazolin immediately after induction. After surgery, patients randomly were assigned to receive no additional antibiotics or five additional doses every 12 hours. Patients were stratified according to type of surgery and were followed for 30 days after surgery.

Sample Characteristics:

  • N = 325  
  • MEAN AGE = 68 years
  • AGE RANGE = 33–91 years
  • MALES: 72%, FEMALES: 28%
  • KEY DISEASE CHARACTERISTICS: All had gastric cancer; 97% had total gastrectomy; 38 patients had laparoscopic procedures.

Setting:

  • SITE: Single site 
  • SETTING TYPE: Inpatient 
  • LOCATION: Japan

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Active antitumor treatment
  • APPLICATIONS: Elder care

Study Design:

  • RCT

Measurement Instruments/Methods:

  • Centers for Disease Control and Prevention definitions of surgical infections were followed.

Results:

Overall surgical site infection incidence was 9.1% in the single-dose group and 6.2% in the multiple-dose group. This difference was not statistically significant. Analysis showed that risk of infection was higher in cases with greater blood loss, body mass index of 25 kg/m2 or higher, and older age.

Conclusions:

No significant difference was seen in post-operative infection rates between those who received single- versus multiple-dose antibiotic prophylaxis.

Limitations:

  • Risk of bias (no blinding)

 

Nursing Implications:

This study showed no statistically significant difference in surgical site infections with single- versus multiple-dose antibiotic prophylaxis. However, this may be questioned—particularly in high-risk patients—if the approximate 3% difference is clinically meaningful. Further research regarding optimal prophylaxis in the highest-risk populations would be helpful.

Imamura, H., Kurokawa, Y., Tsujinaka, T., Inoue, K., Kimura, Y., Iijima, S., . . . Furukawa, H. (2012). Intraoperative versus extended antimicrobial prophylaxis after gastric cancer surgery: A phase 3, open-label, randomised controlled, non-inferiority trial. Lancet Infectious Diseases, 12, 381–387.

doi: 10.1016/S1473-3099(11)70370-X
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Study Purpose:

The purpose of the study was compare surgical site infection rates between intraoperative antibiotic therapy alone versus intraoperative and postoperative antibiotic administration in patients undergoing distal gastrectomy surgery for potentially curable gastric cancer.

Intervention Characteristics/Basic Study Process:

Participants were randomly assigned to receive either intraoperative antimicrobial prophylaxis alone or intraoperative antimicrobial prophylaxis plus extended use of prophylactic antibiotic administration for two days postoperatively. Patients were monitored for surgical site infections for 30 days postoperatively.

Sample Characteristics:

  • The total sample size was 355 with an average age of 65.5 years (range = 35–84)
  • Males made up 68% of the sample; females made up 32%
  • A key disease characteristic was gastric adenocarcinoma considered curable with distal gastrectomy.

Setting:

Multiple inpatient settings in Japan

Phase of Care and Clinical Applications:

Active antitumor treatment

Study Design:

Randomized, controlled trial (non-blinded)

Measurement Instruments/Methods:

The Centers for Disease Control and Prevention's National Nosocomial Infection Surveillance System

Results:

The group that received intraoperative antibiotics only had a lower rate of surgical site infections (5%) than the group that received intraoperative and extended antibiotic prophylaxis (9%). This indicates statistically significant non-inferiority (p < 0.0001). The authors also studied subgroups of patient characteristics, including length of surgery, body mass index, and prognostic nutritional index. None of these subgroups showed benefit from extended antimicrobial administration.

Conclusions:

Interestingly, those patients who got more doses of antibiotic had nearly double the rate of surgical site infection as those who received intraoperative antibiotic prophylaxis only. Additional study is warranted to determine if limited antimicrobial prophylaxis is superior in preventing infection.

Limitations:

Risk of bias (no blinding)

Nursing Implications:

Because elimination of postoperative antibiotic prophylaxis did not negatively affect surgical wound infection rates, this intervention is not recommended. Elimination of the unnecessary treatment will reduce expense, free up pharmacy and nursing time (further reducing expense), and reduce the potential for antibiotic resistance.


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