title: Antimicrobial prophylaxis for the prevention of surgical site infection after thyroid and parathyroid surgery: a prospective randomized trial.
abstract: OBJECTIVE
  The effectiveness of antimicrobial prophylaxis (AMP) in the prevention of surgical site infection (SSI) following thyroid and parathyroid surgery remains uncertain. The objective of this prospective randomized controlled trial (Ito-RCT1) was to assess the effectiveness of AMP in clean neck surgery performed to treat thyroid and parathyroid disease.
  
  
  METHODS
  Participants comprised patients scheduled for clean neck surgery for thyroid and parathyroid disease at Ito Hospital. Patients whose surgery included sternotomy or resection of the trachea, larynx, pharynx, or esophagus were excluded. AMP consisted of 2 g of piperacillin (PIPC) (group A, n = 541) or 1 g of cefazolin (CEZ) (group B, n = 541) administered intravenously immediately after endotracheal intubation. Patients in the control group (Group C, n = 1,082) did not receive AMP.
  
  
  RESULTS
  Statistical analysis was performed to compare the AMP group (Group A + Group B) with the control group (Group C). Drug-induced acute reactions correlated to PIPC or CEZ did not occur in the AMP group. No significant differences in the postoperative incidence of liver or renal dysfunction were seen between the AMP and control groups. Postoperative incidence of urinary tract infection was significantly higher in the control group (p = 0.002). The incidence of SSI events was very low, with only 1 event (0.09 %) in the AMP group and 3 events (0.28 %) in the control group, and this difference between groups was not significant (p = 0.371).
  
  
  CONCLUSIONS
  AMP is not necessary to prevent SSI after clean thyroid or parathyroid surgery.
authors.affiliation: Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan, t-uruno@ito-hospital.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Uruno
authors.forename: Chie
authors.initials: C
authors.lastname: Masaki
authors.forename: Akifumi
authors.initials: A
authors.lastname: Suzuki
authors.forename: Keiko
authors.initials: K
authors.lastname: Ohkuwa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shibuya
authors.forename: Wataru
authors.initials: W
authors.lastname: Kitagawa
authors.forename: Mitsuji
authors.initials: M
authors.lastname: Nagahama
authors.forename: Kiminori
authors.initials: K
authors.lastname: Sugino
authors.forename: Koichi
authors.initials: K
authors.lastname: Ito
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002437:Cefazolin / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010279:Parathyroid Diseases / Q000601:surgery*; D010878:Piperacillin / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013959:Thyroid Diseases / Q000601:surgery*; D014552:Urinary Tract Infections / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002437:Cefazolin; D010878:Piperacillin