title: Prolonged antibiotic prophylaxis longer than 24 hours does not decrease surgical site infection after elective gastric and colorectal surgery.
abstract: OBJECTIVE
  Prophylactic administration of antibiotics can decrease postoperative morbidity, shorten hospitalization, and reduce overall costs. In Western countries, it is stressed that antimicrobial prophylaxis was discontinued within 24 hrs after surgery in currently published guidelines. However, it is unclear how long we need to continue perioperative prophylaxis for gastrointestinal surgery. In this manuscript, we analyzed surgical site infection (SSI) in gastric and colorectal surgery according to the duration of antibiotics prophylaxis and discuss the duration of an antibiotic prophylaxis, and its relation to SSI.
  
  
  METHODS
  We studied 228 patients who underwent digestive surgery including 94 with gastric cancer, 85 with colon cancer and 49 with rectal cancer.
  
  
  RESULTS
  Overall SSI was seen in 28 cases (12.2%), 8 cases (8.5%) in gastrectomy, 10 cases (11.8%) in colectomy and 10 cases (20.4%) in rectal surgery. In SSI positive cases, operative time was longer (p=0.01), blood loss was more (p=0.01) and duration was longer (p=0.01) than in SSI negative cases. The duration of prophylactic antibiotics was significantly longer in 28 patients with SSI than in the 200 non-SSI patients (3.5 +/- 1.8 vs. 2.3 +/- 1.7 days; p<0.05).
  
  
  CONCLUSIONS
  From our findings, SSI rate did not decrease with longer duration of antimicrobial prophylaxis. We concluded that we must recognize that the cause of postoperative wound infection is multimodal, and should not rely on antibiotics to prevent postoperative SSI but that surgeons should reduce the risk for postoperative SSI.
authors.affiliation: Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi 371-8511, Japan. tsuehiro@med.gunma-u.ac.jp
authors.forename: Taketoshi
authors.initials: T
authors.lastname: Suehiro
authors.forename: Teijiro
authors.initials: T
authors.lastname: Hirashita
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Araki
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsumata
authors.forename: Soichi
authors.initials: S
authors.lastname: Tsutsumi
authors.forename: Erito
authors.initials: E
authors.lastname: Mochiki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kato
authors.forename: Takayuki
authors.initials: T
authors.lastname: Asao
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kuwano
mesh_terms: D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D003082:Colectomy / Q000009:adverse effects*; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013997:Time Factors