title: Duration of antimicrobial prophylaxis in patients undergoing hepatectomy: a prospective randomized controlled trial using flomoxef.
abstract: OBJECTIVE
  Although the usefulness of antimicrobial prophylaxis for clean-contaminated surgery has been recognized, only a few randomized controlled studies on the duration of administration after hepatectomy have been performed. We investigated the duration of antimicrobial prophylaxis after hepatectomy.
  
  
  METHODS
  The subjects were 180 patients who underwent hepatectomy without reconstruction of the biliary or intestinal tract between April 2003 and March 2006 at our department. The patients were randomly allocated to groups to be treated with flomoxef sodium as antimicrobial prophylaxis for 2 days (89 patients) or 5 days (91 patients), including the operation day. The presence or absence of systemic inflammatory response syndrome (SIRS) and infections was investigated.
  
  
  RESULTS
  No significant differences were noted in patient background between the two groups. Infections occurred in seven and six patients in the 2 day and 5 day treatment groups (7.9% and 6.6%), respectively, showing no significant difference between the two groups. No significant difference was noted when the cases were divided into surgical site infections and remote infections. The positive rate of SIRS was significantly higher in the 2 day treatment group than in the 5 day treatment group on days 2 and 3 after surgery. The risk factors in patients who developed infections were blood loss, operation time and the complication of biliary fistula.
  
  
  CONCLUSIONS
  Two day administration of flomoxef sodium may be sufficient for antimicrobial prophylaxis after hepatectomy. However, when SIRS is positive on post-operative day 2, and induction of liver failure is of concern, it may be safer to continue antimicrobial drug administration until SIRS is eliminated.
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan. togo@med.yokohama-cu.ac.jp
authors.forename: Shinji
authors.initials: S
authors.lastname: Togo
authors.forename: Kuniya
authors.initials: K
authors.lastname: Tanaka
authors.forename: Kenichi
authors.initials: K
authors.lastname: Matsuo
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Nagano
authors.forename: Michio
authors.initials: M
authors.lastname: Ueda
authors.forename: Daisuke
authors.initials: D
authors.lastname: Morioka
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimada
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D002511:Cephalosporins / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy / Q000517:prevention & control*; D018746:Systemic Inflammatory Response Syndrome / Q000188:drug therapy / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; C045693:flomoxef