Antibiotic Prophylaxis for Surgical Site Infection in General Surgery: Oncological Treatments and HIPEC.

Carlo Vallicelli,Massimo Sartelli,Simona Bui,Federico Coccolini,Luca Ansaloni,Fausto Catena

doi:10.3390/antibiotics11010043

Abstract

The procedure of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a combined surgical and oncological treatment for peritoneal carcinomatosis of various origins. Antibiotic prophylaxis is usually center-related and should be discussed together with the infectious disease specialist, taking into account the advanced oncologic condition of the patient, the complexity of surgery—often requiring multiorgan resections—and the risk of post-HIPEC neutropenia. The incidence of surgical site infection (SSI) after CRS and HIPEC ranges between 11 and 46%. These patients are also at high risk of postoperative abdominal infections and septic complications, and a bacterial translocation during HIPEC has been hypothesized. Many authors have proposed aggressive screening protocols and a high intra and postoperative alert, in order to minimize and promptly identify all possible infectious complications following CRS and HIPEC.

Highlights

Background and Current EvidenceThe procedure of cytoreductive surgery (CRS) and hypertermic intraperitoneal chemotherapy (HIPEC) is a combined surgical and oncological treatment for peritoneal carcinomatosis of various origins
CRS and HIPEC is a complex procedure performed in advanced oncologic patients, and abdominal infectious complications are the most frequently encountered complications in the postoperative course
The role of antibiotic prophylaxis has been strongly debated, and many authors argue that a “simple” pre and intra-operative prophylaxis may be not sufficient in these patients due to the high risk of endogenous colonization from microorganisms with a potential role in the following development of infections

Summary

Background and Current Evidence

The procedure of cytoreductive surgery (CRS) and hypertermic intraperitoneal chemotherapy (HIPEC) is a combined surgical and oncological treatment for peritoneal carcinomatosis of various origins. According to the ERAS Society guidelines, oral antibiotics together with mechanical bowel preparation can be proposed in patients undergoing CRS and HIPEC in case of probable rectal resection. Preoperative mechanical bowel preparation alone for patients undergoing CRS and HIPEC, including probable colectomy, should not be indicated to reduce the incidence of surgical site infection. We routinely perform antifungal prophylaxis as well, due to the risk of post-HIPEC neutropenia It has to be taken into account that according to ASCO (the American Society of Clinical Oncology) guidelines, antibiotic prophylaxis with fluoroquinolone is recommended for patients who are at high risk of febrile neutropenia or profound, protracted neutropenia. Multiple factors, both surgery-related and patient-related, can influence the most appropriate regimen. This situation highlights the need of collaborative research and the spread of data sharing within all the high-volume institutes dedicated to HIPEC surgery

Post-HIPEC Infectious Complications

Findings

Conclusions