Appropriateness of surgical antimicrobial prophylaxis in Japanese university hospitals

Morioka, Hiroshi; Ohge, Hiroki; Nagao, Miki; Kato, Hideaki; Kokado, Ryohei; Yamada, Koichi; Yamada, Takahiro; Shimono, Nobuyuki; Nukui, Yoko; Yoshihara, Shingo; Sakamaki, Ippei; Nosaka, Kisato; Kubo, Yuko; Kawamura, Hideki; Fujikura, Yuji; Kitaura, Tsuyoshi; Sunakawa, Mitsuhiro; Yagi, Tetsuya

doi:10.1016/j.jhin.2022.06.017

Cited by 6 publications

(2 citation statements)

References 19 publications

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“…6,15 We consider adherence to these recommendations in esophagectomy to be high in Japan, analogous to the high adherence in gastrectomy ( > 90%) reported by a national surveillance study. 50 Fifth, the optimal duration of antimicrobial prophylaxis could not be ascertained by the current study. Previous studies showing the effectiveness of ABPC/SBT (or amoxicillinclavulanate) for pneumonia prevention preferred regimens for 24 hours or 2 days postoperatively.…”

Section: Discussionmentioning

confidence: 76%

“…The Japanese SSI guidelines recommend initiation of antimicrobial administration within 60 minutes before surgical incision and antimicrobial-specific redosing intervals during surgery (eg, CEZ, every 3–4 hours and ABPC/SBT, every 2–3 hours for patients with estimated glomerular filtration rate≥50 mL/min), 7 in line with other guidelines 6,15 . We consider adherence to these recommendations in esophagectomy to be high in Japan, analogous to the high adherence in gastrectomy (>90%) reported by a national surveillance study 50 . Fifth, the optimal duration of antimicrobial prophylaxis could not be ascertained by the current study.…”

Section: Discussionmentioning

confidence: 86%

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Antimicrobial Prophylaxis with Ampicillin-sulbactam Compared with Cefazolin for Esophagectomy

Hirano,

Konishi,

Kaneko

et al. 2023

Annals of Surgery

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Objective: To assess the effect of antimicrobial prophylaxis with ampicillin-sulbactam (ABPC/SBT) compared with cefazolin (CEZ) on the short-term outcomes after esophagectomy. Summary Background Data: CEZ is widely used for antimicrobial prophylaxis in esophagectomy without procedure-specific evidence, whereas ABPC/SBT is preferred in some hospitals to target both aerobic and anaerobic oral bacteria. Methods: Data of patients who underwent esophagectomy for cancer between July 2010 and March 2019 were extracted from a nationwide Japanese inpatient database. Overlap propensity score weighting was conducted to compare the short-term outcomes [including surgical site infection (SSI), anastomotic leakage, and respiratory failure] between antimicrobial prophylaxis with CEZ and ABPC/SBT, after adjusting for potential confounders. Sensitivity analyses were also performed using propensity score matching and instrumental variable analyses. Results: Among 17,772 eligible patients, 16,077 (90.5%) and 1695 (9.5%) patients were administered CEZ and ABPC/SBT, respectively. SSI, anastomotic leakage, and respiratory failure occurred in 2971 (16.7%), 2604 (14.7%), and 2754 patients (15.5%), respectively. After overlap weighting, ABPC/SBT was significantly associated with a reduction in SSI [odds ratio 0.51 (95% confidence interval 0.43–0.60)], anastomotic leakage [0.51 (0.43–0.61)], and respiratory failure [0.66 (0.57–0.77)]. ABPC/SBT was also associated with reduced respiratory complications, postoperative length of stay, and total hospitalization costs. The proportion of Clostridioides difficile colitis and noninfectious complications did not differ between the groups. Propensity score matching and instrumental variable analyses demonstrated equivalent results. Conclusions: The administration of ABPC/SBT as antimicrobial prophylaxis for esophagectomy was associated with better short-term postoperative outcomes compared to CEZ.

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Section: Discussionmentioning

confidence: 76%