Abstract
Surgical site infection occurs with high frequency in gastrointestinal surgery, contributing to the high incidence of morbidity and mortality. The accepted practice worldwide for the prevention of surgical site infection is providing single- or multiple-dose antimicrobial prophylaxis. However, most suitable antibiotic and optimal duration of prophylaxis are still debated. The aim of the systematic review is to assess the efficacy of antimicrobial prophylaxis in controlling surgical site infection rate following esophagogastric surgery. PubMed and Cochrane databases were systematically searched until 31 October 2021, for randomized controlled trials comparing different antimicrobial regimens in prevention surgical site infections. Risk of bias of studies was assessed with standard methods. Overall, eight studies concerning gastric surgery and one study about esophageal surgery met inclusion criteria. No significant differences were detected between single- and multiple-dose antibiotic prophylaxis. Most trials assessed the performance of cephalosporins or inhibitor of bacterial beta-lactamase. Antimicrobial prophylaxis (AMP) is effective in reducing the incidence of surgical site infection. Multiple-dose antimicrobial prophylaxis is not recommended for patients undergoing gastric surgery. Further randomized controlled trials are needed to determine the efficacy and safety of antimicrobial prophylaxis in esophageal cancer patients.
Highlights
Surgical site infection (SSI) represents a common cause of morbidity and mortality occurring after gastrointestinal surgeries [1], with an average incidence of 10–25% reported in recent literature [2]
Despite recent advances in infection prevention efforts, the efficacy of antimicrobial prophylaxis (AMP) in esophageal and gastric surgery remains debatable. Another unsolved topic is the optimal duration of prophylaxis
On the other hand, extended AMP is still adopted in surgical practices, especially in Eastern
Summary
Short-term use of antimicrobial prophylaxis (AMP), limited to the intraoperative period or within 24 h postoperatively, prevents postoperative SSI in biliary and colorectal surgery [3,4,5,6,7,8]. Despite recent advances in infection prevention efforts, the efficacy of AMP in esophageal and gastric surgery remains debatable. Another unsolved topic is the optimal duration of prophylaxis. The US Centers for Disease Control and Prevention (CDC) and the Healthcare Infection Control Practices Advisory Committee (HICPAC) emphasized the role of short-term AMP in SSI prevention as a measure of quality of care in gastrointestinal surgery [9,10,11]. On the other hand, extended AMP is still adopted in surgical practices, especially in Eastern
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