J.Jpn. Surg. Soc.
ISSN 1880-1129

[Abstract] [Full Text PDF] （in Japanese / 570KB） [Members Only And Two Factor Auth.]

J.Jpn. Surg. Soc.. 93(2): 162-168, 1992

Original article

IDENTIFICATION AND ANTIBIOTIC PROPHYLAXIS OF HIGH-RISK PATIENTS IN BILIARY TRACT SURGERY

1) The First Department of Surgery, Nagoya City University Medical School, Nagoya, Japan
2) Department of Surgery, Inabe Kosei Hospital, Mie, Japan
3) Department of Surgery, Chita Kosei Hospital, Aichi, Japan
4) Department of Surgery, Kariya General Hospital, Kariya, Japan

Nagao Shinagawa1), Jiro Yura1), Shu Ishikawa1), Keiji Mashita1), Akio Inukai2), Akihiko Iwai3), Takashi Okubo4)

A prospective randomized trial has compared 3 policies of antibiotic prophylaxis in biliary surgery. Patients considered to be high-risked against postoperative infection were randomly allocated to 2 groups: in group CTM-H, patients were given cefotiam; in group CMX-H, patients were given cefmenoxime. Patients free of risk factors (group CTM-L) were all given cefotiam. The high-risk factors adopted in this trial were; emergency surgery, presence of jaundice or chirrosis, malignant disease, diabetes mellitus, age over 70, recent biliary tract infection, choledocholithiasis, and previous biliary surgery. Postoperative infection occurred in 2.1% (4/190) in the CTM-L group, which was lower compared to 15.5% (11/71) of the CMT-H group (p<0.01), and 11.3% (8/71) of the CTM-H group (p<0.01). The rates of bacterial isolation from intraoperative bile culture and wound swab were significantly high in the two high-risk groups compared to the low-risk group, but is was not different within the two high-risk groups. These findings suggest that while cefotiam is approprite for prophylaxis for the low-risk patients, the utmost care should be taken in the high-risk patients to prevent intraoperative contamination along with prophylactic antibiotic therapy which covers the bacteria isolated from the bile.

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