Duration of antimicrobial prophylaxis in patients undergoing hepatectomy: a prospective randomized controlled trial using flomoxef.
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.
Togo
Shinji
S
Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan. togo@med.yokohama-cu.ac.jp
Tanaka
Kuniya
K
Matsuo
Kenichi
K
Nagano
Yasuhiko
Y
Ueda
Michio
M
Morioka
Daisuke
D
Endo
Itaru
I
Shimada
Hiroshi
H
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
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; C045693:flomoxef