title: The significance of the intraoperative repeated dosing of antimicrobials for preventing surgical wound infection in colorectal surgery.
abstract: OBJECTIVE
  It is widely accepted that antimicrobial prophylaxis is useful for the prevention of surgical wound infection, especially in colorectal surgery. While many reports support the finding that the first dose should be administered immediately before surgery, there is less evidence concerning the ideal timing for the second dose. The purpose of this study is to examine the significance of intraoperative repeated dosing.
  
  
  METHODS
  A surgical series of 131 patients with primary colorectal cancer was retrospectively analyzed for 14 parameters, including the protocols of antimicrobial administration to determine the clinical risk factors for surgical wound infection.
  
  
  RESULTS
  The overall surgical wound infection rate of the 131 patients was 16.0% (21/131). When the operation finished within 4 h after the first dose (n = 29), wound infection was observed in only one patient (3.4%). In a prolonged operation exceeding 4 h after the first dose, the surgical wound infection rates were 8.5% and 26.5%, respectively, for those with (n = 47) and without (n = 49) intraoperative repeated dosing, which were significantly different based on both a univariate analysis (P = 0.031) and a multivariate analysis (P = 0.0079).
  
  
  CONCLUSIONS
  Intraoperative repeated antimicrobial dosing is therefore recommended to prevent the surgical wound infection for prolonged colorectal surgery.
authors.affiliation: Department of Surgery, Yao Municipal Hospital, 1-3-1 Ryuge-cho, Yao, Osaka, 581-0069, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Morita
authors.forename: Isamu
authors.initials: I
authors.lastname: Nishisho
authors.forename: Takashi
authors.initials: T
authors.lastname: Nomura
authors.forename: Yukio
authors.initials: Y
authors.lastname: Fukushima
authors.forename: Takashi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Hiraoka
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Shibata
mesh_terms: D000368:Aged; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002437:Cefazolin / Q000008:administration & dosage; D015311:Cefmetazole / Q000008:administration & dosage; D015310:Cefotiam / Q000008:administration & dosage; D002511:Cephalosporins / Q000008:administration & dosage; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013530:Surgical Wound Infection / Q000517:prevention & control*; D000097586:Cefozopran
chemical_list: D002437:Cefazolin; D015311:Cefmetazole; D015310:Cefotiam; D002511:Cephalosporins; D000097586:Cefozopran; C045693:flomoxef