[Identification and antibiotic prophylaxis of high-risk patients in biliary tract surgery].
A prospective randomized trial has compared 3 policies of antibiotic prophylaxis in biliary surgery. Patients considered to be high-risked against postoperative infection were randomly allocated to 2 groups: in group CTM-H, patients were given cefotiam; in group CMX-H, patients were given cefmenoxime. Patients free of risk factors (group CTM-L) were all given cefotiam. The high-risk factors adopted in this trial were; emergency surgery, presence of jaundice or cirrhosis, malignant disease, diabetes mellitus, age over 70, recent biliary tract infection, choledocholithiasis, and previous biliary surgery. Postoperative infection occurred in 2.1% (4/190) in the CTM-L group, which was lower compared to 15.5% (11/71) of the CMT-H group (p less than 0.01), and 11.3% (8/71) of the CTM-H group (p less than 0.01). The rates of bacterial isolation from intraoperative bile culture and wound swab were significantly high in the two high-risk groups compared to the low-risk group, but is was not different within the two high-risk groups. These findings suggest that while cefotiam is appropriate for prophylaxis for the low-risk patients, the utmost care should be taken in the high-risk patients to prevent intraoperative contamination along with prophylactic antibiotic therapy which covers the bacteria isolated from the bile.
Shinagawa
N
N
First Department of Surgery, Nagoya City University Medical School, Japan.
Yura
J
J
Ishikawa
S
S
Mashita
K
K
Inukai
A
A
Iwai
A
A
Okubo
T
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000517:prevention & control*; D001660:Biliary Tract Diseases / Q000601:surgery*; D015281:Cefmenoxime / Q000627:therapeutic use*; D015310:Cefotiam / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D006801:Humans; D008875:Middle Aged; D011292:Premedication; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*
D015310:Cefotiam; D015281:Cefmenoxime