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.

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

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.

• 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.

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

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

• RCT

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

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.

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

• Risk of bias (no blinding)

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.