title: Extended antimicrobial prophylaxis after gastric cancer surgery: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To investigate the efficacy of extended antimicrobial prophylaxis (EAP) after gastrectomy by systematic review of literature and meta-analysis.
  
  
  METHODS
  Electronic databases of PubMed, Embase, CINAHL, the Cochrane Database of Systematic Reviews, the Cochrane Controlled Trials Register and the China National Knowledge Infrastructure were searched systematically from January 1980 to October 2012. Strict literature retrieval and data extraction were carried out independently by two reviewers and meta-analyses were conducted using RevMan 5.0.2 with statistics tools risk ratios (RRs) and intention-to-treat analyses to evaluate the items of total complications, surgical site infection, incision infection, organ (or space) infection, remote site infection, anastomotic leakage (or dehiscence) and mortality. Fixed model or random model was selected accordingly and forest plot was conducted to display RR. Likewise, Cochrane Risk of Bias Tool was applied to evaluate the quality of randomized controlled trials (RCTs) included in this meta-analysis.
  
  
  RESULTS
  A total of 1095 patients with gastric cancer were enrolled in four RCTs. No statistically significant differences were detected between EAP and intraoperative antimicrobial prophylaxis (IAP) in total complications (RR of 0.86, 95%CI: 0.63-1.16, P = 0.32), surgical site infection (RR of 1.97, 95%CI: 0.86-4.48, P = 0.11), incision infection (RR of 4.92, 95%CI: 0.58-41.66, P = 0.14), organ or space infection (RR of 1.55, 95%CI: 0.61-3.89, P = 0.36), anastomotic leakage or dehiscence (RR of 3.85, 95%CI: 0.64-23.17, P = 0.14) and mortality (RR of 1.14, 95%CI: 0.10-13.12; P = 0.92). Likewise, multiple-dose antimicrobial prophylaxis showed no difference compared with single-dose antimicrobial prophylaxis in surgical site infection (RR of 1.10, 95%CI: 0.62-1.93, P = 0.75). Nevertheless, EAP showed a decreased remote site infection rate compared with IAP alone (RR of 0.54, 95%CI: 0.34-0.86, P = 0.01), which is the only significant finding. Unfortunately, EAP did not decrease the incidence of surgical site infections after gastrectomy; likewise, multiple-dose antimicrobial prophylaxis failed to decrease the incidence of surgical site infection compared with single-dose antimicrobial prophylaxis.
  
  
  CONCLUSIONS
  We recommend that EAP should not be used routinely after gastrectomy until more high-quality RCTs are available.
authors.affiliation: Department of Gastrointestinal Surgery, the Fourth Affiliated Hospital of China Medical University, Shenyang 110032, Liaoning Province, China.
authors.forename: Chun-Dong
authors.initials: CD
authors.lastname: Zhang
authors.forename: Yong-Ji
authors.initials: YJ
authors.lastname: Zeng
authors.forename: Zhen
authors.initials: Z
authors.lastname: Li
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.forename: Hong-Wu
authors.initials: HW
authors.lastname: Li
authors.forename: Jia-Kui
authors.initials: JK
authors.lastname: Zhang
authors.forename: Dong-Qiu
authors.initials: DQ
authors.lastname: Dai
mesh_terms: D057868:Anastomotic Leak; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000517:prevention & control*; D006801:Humans; D007432:Intraoperative Period; D011183:Postoperative Complications / Q000175:diagnosis; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D016896:Treatment Outcome; D014946:Wound Infection / Q000628:therapy
chemical_list: D000890:Anti-Infective Agents
keywords: Extended antimicrobial prophylaxis; Gastrectomy; Gastric cancer; Intraoperative antimicrobial prophylaxis; Meta-analysis