Antimicrobial Prophylaxis Reduces the Rate of Surgical Site Infection in Upper Gastrointestinal Surgery: A Systematic Review

Abstract

Surgical site infection occurs with high frequency in gastrointestinal surgery, contributing to the high incidence of morbidity and mortality. The accepted practice worldwide for the prevention of surgical site infection is providing single- or multiple-dose antimicrobial prophylaxis. However, most suitable antibiotic and optimal duration of prophylaxis are still debated. The aim of the systematic review is to assess the efficacy of antimicrobial prophylaxis in controlling surgical site infection rate following esophagogastric surgery. PubMed and Cochrane databases were systematically searched until 31 October 2021, for randomized controlled trials comparing different antimicrobial regimens in prevention surgical site infections. Risk of bias of studies was assessed with standard methods. Overall, eight studies concerning gastric surgery and one study about esophageal surgery met inclusion criteria. No significant differences were detected between single- and multiple-dose antibiotic prophylaxis. Most trials assessed the performance of cephalosporins or inhibitor of bacterial beta-lactamase. Antimicrobial prophylaxis (AMP) is effective in reducing the incidence of surgical site infection. Multiple-dose antimicrobial prophylaxis is not recommended for patients undergoing gastric surgery. Further randomized controlled trials are needed to determine the efficacy and safety of antimicrobial prophylaxis in esophageal cancer patients.

Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious Issues

“…More extended lymphadenectomy should only be performed in dedicated highvolume hospitals, due to the high risk of post-operative complications and mortality [60].…”

Meta-Analysis of Clinical Trials Comparing Cefazolin to Cefuroxime, Ceftriaxone, and Cefamandole for Surgical Site Infection Prevention

“…Marano et al reported that using antimicrobials such as cefazolin and cefuroxime during esophagogastric surgery to reduce infections within the intraoperative period should not exceed two antimicrobial agents, at the lowest efficacious and safe doses to avoid the emergence of multi-drug resistance [ 53 ]. They reported that further studies are needed to investigate the optimal antimicrobial regimen in esophageal surgery [ 53 ].…”

“…Marano et al reported that using antimicrobials such as cefazolin and cefuroxime during esophagogastric surgery to reduce infections within the intraoperative period should not exceed two antimicrobial agents, at the lowest efficacious and safe doses to avoid the emergence of multi-drug resistance [ 53 ]. They reported that further studies are needed to investigate the optimal antimicrobial regimen in esophageal surgery [ 53 ]. Ruol et al stated that a single-dose prophylactic regimen provides adequate prophylaxis and significant cost-savings in comparison with multiple-dose prophylactic regimens in patients undergoing major surgery for esophageal cancer [ 54 ].…”

Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: An Italian single-institution 5-year experience analysis and updated literature review

“…The THD is a safe and effective atraumatic technique associated, not influencing sphincter complex or anal function, with the best short-term clinical and surgical outcomes (rapid symptoms relief, lesser surgical site infection ( 53 ) and postoperative complications). Fast postoperative recovery, early discharge, and quickly return to normal daily activities and works substantially improves patient's QoL ( 54 ).…”