Cefoxitin versus Cefepime for the Prevention of Perioperative Infection in Elderly Patients Undergoing Colorectal Cancer Surgery: A Retrospective Study

Abstract

Background The optimal antibiotic prophylaxis in preventing perioperative infection in patients aged 70 who underwent colorectal cancer surgery of are unknown. We conducted a comparative analysis to evaluate the efficacy of cefoxitin and cefepime in preventing perioperative infections and assessed the inflammatory response to antibiotics during the perioperative period. Methods Patients over 70 years old and undergo surgery for colorectal cancer between January 2021 and June 2022 at the same ward of a tertiary teaching hospital in Shanghai, China were included. Demographic and clinical data were retrieved from hospital information system (HIS) to evaluate the body reaction of two antibiotic prophylaxis: patients in Group A received cefoxitin and in Group B accepted cefepime after surgery. Both antibiotics were intravenous 2000mg, two times daily, total 3 days. The effect of perioperative prevention was compared between two groups with any infection complications, hospital length of stay (HLOS), postoperative length of stay (POLS) and mortality during hospitalization. Results A total of 107 elderly patients (56 patients in Group A and 51 patients in Group B) with colorectal cancer were included. Two groups were similar in terms of tumor stage and other basic demographic. Patients received cefoxitin demonstrated lower infection complications (12.5% vs 13.7%, P = 0.851), among which surgical site infection (SSI) were most frequent complications in both groups (8.5% vs 9.8%, P = 0.877). However, patients with cefepime represented shorter HLOS (14.0 ± 4.7 days vs 13.9 ± 3.8 days, P = 0.912) and PLOS (9.4 ± 3.8 days vs 8.4 ± 2.1 days, P = 0.265). Additionally, the percentage of cluster of differentiation (CD) 4 + cell was significantly higher (29.2%±9.2 vs 46.5%±10.0, P = 0.001) and the percentage of CD8 + cell was statistical lower (26.1% [23.1, 34.4] vs 19.2% [15.5, 20.4], P = 0.004) in Group B compared to Group A at the third postoperative day. No death occurred in both groups. Conclusion Cefepime and cefoxitin both serve as useful prophylaxis to reduce infectious complications among elder patients underwent surgery for colorectal cancer. However, cefepime illustrated a more active inflammatory response and might enhance the body recovery in early post-operative rehabilitation.