European Journal of Cardio-Thoracic Surgery, Vol 6, 561-564, Copyright © 1992 by European Association for Cardio-thoracic Surgery
Antibiotic prophylaxis in oesophageal surgery
DA Sharpe, P Renwick, KH Mathews and K Moghissi
North Humberside Cardiothoracic Centre, Castle Hill Hospital, Cottingham, UK.
A prospective randomised study to assess the efficacy of antibiotic
prophylaxis in oesophageal surgery was performed, in which 226 consecutive
patients (113 male and 113 female, age range 24-86 years, mean age of 65
years) were included. The study patients were in two groups: group 1, in
which the upper alimentary tract was opened during surgery, and group 2, in
which it was not. The group 1 patients (n = 129) were randomised to one of
three antibiotic prophylaxis regimes prior to surgery. Group A patients (n
= 42) were treated with cefuroxime (CFX) 1.5 g at induction of anaesthesia
and then CFX 750 mg b.i.d. for 4 days. Group B patients (n = 46) were
treated with CFX 1.5 g and metronidazole (MTR) 1.0 g at induction of
anaesthesia, then CFX 750 mg b.i.d. and MTR 500 mg qds for 4 days. Group C
(n = 41) treated with CFX 1.5 g and MTR 1.0 g at the induction of
anaesthesia. Group 2 (n = 97) was divided into two groups, group D (n = 47)
treated with CFX 1.5 g on induction of anaesthesia alone. Group E (n = 50)
treated with CFX 1.5 g on induction of anaesthesia then CFX 750 mg bd for 2
days. We found a significantly higher incidence of infective complications
in subgroup C (43.9%) and subgroup A (21.4%) compared to subgroup B (8.6%).
This difference was most marked in patients undergoing oesophagectomy. We
found significantly higher infection rates of infective complications in
subgroup D (10.6%) as compared to subgroup E (2%).
