Perioperative application of preventive antibiotics for patients with esophageal carcinoma

Abstract

Objective To analyze the distribution and antibiotic resistance of pathogens isolated from sputum in early postoperative patients after esophageal surgery, and investigate the risk factors of pulmonary infections after esophageal carcinoma and reasonable application of antibiotics during perioperative period. Methods The clinical data of 414 patients with esophageal carcinoma who were admitted to the Affiliated Hospital of Binzhou Medical University from January 2012 to June 2014 were retrospectively analyzed. The second generation cephalosporins were used as preventive antibiotics for the 181 patients between January and December 2012 and the third generation cephalosporins were used for the 233 patients between January 2013 and June 2014. Sputum samples were collected and inspected before operation and in the first three days after operation for observing distribution and antibiotic resistance of pathogens. The incidence of postoperative pulmonary infection was observed in the two kinds of patients. The risk factors closely related to the occurrence of postoperative pulmonary infections were analyzed. Comparison of rate and univariate analysis were done by chi-square test. Multivariate analysis was done with logistic regression. Results The positive rate of early post-operative sputum culture was 24.64%(102/414), 32.04%(58/181) in patients receiving the second generation cephalosporins and 18.88%(44/233) in patients receiving the third generation cephalosporins, respectively, with a significant difference between the two generations of cephalosporins (χ2=9.502, P<0.05). A total of 131 strains of pathogens were isolated from early postoperative sputum samples including 12 strains of gram-positive bacteria and 119 strains of gram-negative bacteria. The top three bacteria were Klebsiella pneumoniae subsp pneumoniae (33 trains), Acinetobacter baumannii (20 strains) and Pseudomonas aeruginosa (19 strains). The resistance rate of gram-negative bacteria in early postoperative sputum samples to meropenem, ciprofloxacin and levofloxacin were 5.0%-25.0%, 2.6%-15.2%, 2.6%-20.0%, respectively. Among cephalosporins, the resistance rate to ceftriaxone, cefotaxime, cefepime, ceftazidime, cefuroxime and cefazolin were 10.3%-20.0%, 5.3%-30.0%, 12.8%-31.6%, 15.4%-42.1%, 21.2%-55.0% and 15.2%-60.0%, respectively. The overall postoperative pulmonary infection rate was 18.60%(77/414). The pulmonary infection rate of patients receiving the second generation cephalosporins was 26.52%(48/181), which was higher than 12.45%(29/233) of patients receiving the third generation cephalosporins (χ2=13.326, P<0.05). The results of univariate analysis showed that smoking, chronic obstructive pulmonary disease, application of the second generation cephalosporins during the perioperative period and early postoperative sputum culture positive were correlated with the postoperative pulmonary infection after esophageal carcinoma surgery (χ2=5.149, 22.765, 13.326, 159.092, P<0.05). Multivariate statistical analysis with logistic regression demonstrated that application of the third generation cephalosporins during the perioperative period was independent protective factor of postoperative pulmonary infection (OR=2.582, 95% confidence interval: 1.331-5.009, P<0.05). Conclusions The pathogens from sputum in early postoperative period after esophageal surgery are complicated with gram-negative bacteria as the main pathogens especially Klebsiella pneumoniae subsp, pneumoniae, and different levels of antibiotic resistance are ubiquitous. The third generation cephalosporins can effectively prevent the postoperative pulmonary infection after esophageal carcinoma surgery. Key words: Esophageal neoplasms; Perioperative period; Pulmonary infection; Pathogen; Preventive antibiotics