A controlled trial to compare systemic and intra-incisional cefuroxime prophylaxis in high risk gastric surgery.
A prospective randomized controlled trial has compared single dose systemic cefuroxime (n = 27) or intra-incisional cefuroxime (n = 26) with a control group (n = 28) in 81 patients undergoing gastric resection, revision gastric surgery or operation for gastro-oesophageal malignancy. In the controls the incidence of sepsis was: 35 per cent wound infection, 29 per cent abscess, 21 per cent septicaemia. After intra-incisional cefuroxime the incidence was: 4 per cent wound sepsis, 19 per cent abscess and 4 per cent septicaemia. After systemic cefuroxime only 2 patients developed wound sepsis (7 per cent) with no cases of abscess or septicaemia. Excluded from this high risk group were 36 patients who had a vagotomy with or without drainage during the trial where antibiotics were not given, 4 of whom developed wound sepsis only (11 per cent). There was a poor correlation between the individual species isolated from the gastric aspirate and the organisms responsible for postoperative infection in the controls, but there was a good correlation between fasting gastric pH and the risk of sepsis in the controls.
D001419:Bacteria / Q000302:isolation & purification; D002444:Cefuroxime / Q000008:administration & dosage* / Q000627:therapeutic use; D002511:Cephalosporins / Q000008:administration & dosage*; D002986:Clinical Trials as Topic; D005745:Gastric Acidity Determination; D006801:Humans; D007275:Injections, Intravenous; D008875:Middle Aged; D011292:Premedication; D011446:Prospective Studies; D011897:Random Allocation; D012306:Risk; D013270:Stomach / Q000601:surgery*; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*
D002511:Cephalosporins; D002444:Cefuroxime