Antibiotic prophylaxis in thyroid surgery: a preliminary multicentric italian experience

Abstract

Post-operatory wound infections are a very uncommon finding after thyroidectomy. For these reasons international guidelines do not routinely recommend systemic antibiotic prophylaxis.The benefits of this antibiotic prophylaxis is not supported by clinical evidence in the literature. We have conducted a multicentric randomized double-blind trial on 500 patients who had undergone thyroidectomy for goitre or thyroid carcinoma. The 500 patients enrolled in the study (mean age 47 years) were randomized in two subgroups of 250 patients. 250 patients were treated with standard antibiotic prophylaxis with sulbactam/ampicillin 1 fl (3 gr.) 30 min before surgery. No antibiotic prophylaxis was instituted in the remainder 250 patients. Our RCT showed that prophylactic antibiotic treatment is not beneficial in patients younger than eighty years old, with no concomitant metabolic, infective and hematologic disease, with no cardiac valvulopathies, not under steroidal or immunosuppressive treatment, and not severely obese. Our study should be regarded only as a preliminary RCT, and should be followed by a study in which a larger number of patients should be enrolled so that statistically significant data can be obtained.

The forgotten goiter: casuistic contribution and considerations for the choice of surgical approach

“…In no cases were dysphonia or permanent hypocalcemia observed. All three patients were prescribed antibiotic prophylaxis [4]. Discharge occurred on the eighth postoperative day in the first case, on the sixth postoperative day in second case, and on the third postoperative day in the third case.…”

“…Besides, in cases of true ectopic goiter, the vascular pedicles to the endothoracic source may be difficult to control through the thoracic outlet [15]. The cervicosternotomy (total longitudinal sternotomy and simple sternal split) is the access route preferred by most authors [4,9,12,16]. This approach allows adequate exposure of the anterior vascular mediastinal structures and facilitates the control of possible bleeding with limited trauma.…”

Current Recommendations on Surgical Antimicrobial Prophylaxis

“…Tiroidektomi ve lenf gangliyonu diseksiyonu gibi temiz operasyonlarda CAİ oranı profilaksi verilmediğinde bile %1'in altındadır. Paratiroidektomi, submandibüler gland eksizyonu, tonsillektomi, adenoidektomi, rinoplasti ve mandibula fraktürü onarımı gibi oral faringeal mukoza insizyonu yapılan temiz-kontamine işlemlerde profilaksi uygulanmalıdır (39,40).…”

“…Başlıca orofaringeal mikroorganizmalar, streptokoklar, Bacteroides türleri (B. fragilis dışında), peptostreptokoklar, Prevotella spp., Fusobacterium spp., Veillonella spp., Enterobacteriaceae türleri ve stafilokoklardır. Antimikrobiyal profilaksi temiz girişimlerde uygulanmamalıdır (4,39). Adenoidektomi, tonsillektomi ya da septoplasti gibi operasyonlarda rutin profilaksinin yararı gösterilmemesine rağmen (43,44), çoğu temiz-kontamine girişimde profilaksi uygulanmaktadır (40,45).…”

A multi-center study on the prophylactic application of antibiotics in aseptic operations

“…Principally speaking, broad-spectrum and secure bactericides are preferred, of which cephalosporins are the most suitable (Zhang and Harvey, 2006;Butt et al, 2012). According to the requirements released by the Ministry of Health, first-generation cephalosporins are recommended in thyroid, breast, and abdominal external hernia operations, of which cefazolin or cefradine are given priority (Esposito et al, 2006;Avenia et al, 2009;RodriguezCaravaca et al, 2011). In the 159 cases of these operations, first-generation cephalosporins were used in only 14 cases (8.8%), whereas second-, third-, and fourth-generation cephalosporins were used in 74 cases (46.5%).…”