Is Single-Dose Antimicrobial Prophylaxis Sufficient to Control Infections in Gastrointestinal Oncological Surgeries?

Abstract

Surgical site infections (SSIs) represent one of the most important complications occurring postoperatively following surgical procedures. The SSI incidence is higher following gastrointestinal (GI) surgeries compared to any other surgery. It contributes to the majority of morbidity and mortality in patients undergoing GI surgeries. The accepted practice worldwide for the prevention and control of SSIs is providing antimicrobial prophylaxis. The appropriate antimicrobial and dose are chosen depending on the microbial flora, complications, and patient risk factors. The objective of this review was to determine the sufficient number of prophylactic antimicrobial doses that would be efficacious and safe in controlling the SSIs following GI oncological surgeries. Single-dose antimicrobial prophylaxis has shown the same efficacy as the multipledose antimicrobial regimen in controlling SSIs in esophageal, gastric, and colorectal surgeries. The advantages of a single-dose regimen include less chance of emergence of resistance, less chance for allergies or toxicity, and less cost. The addition of metronidazole with single-dose antimicrobial prophylaxis in colorectal surgery should be considered due to its beneficial effect in further reducing infections. Further randomized controlled trials are needed for the literature to determine the efficacy and safety of single-dose antimicrobial prophylaxis in patients undergoing esophageal and colorectal surgeries. In addition, studies are required to determine the individual effectiveness of metronidazole in controlling SSIs in colorectal surgeries.

Antimicrobial Prophylaxis Reduces the Rate of Surgical Site Infection in Upper Gastrointestinal Surgery: A Systematic Review

“…Short-term prophylaxis seems to be more attractive because it minimizes the outbreak of multidrug-resistant bacteria and Clostridioides difficile disease [ 13 ], reduces the risk of antibiotic-related adverse events [ 14 , 15 , 16 ] (i.e., allergic reactions, antibiotics-associated diarrhea [ 17 , 18 , 19 , 20 ]), and is cheaper than long-term regimens [ 21 ].…”

“…In 1999, the US CDC promulgated the first guidelines in gastrointestinal surgery, and recommended to limit intravenous cefazolin antibiotics within the intraoperative period or within 24 h postoperatively [3,46]. However, while prolonged exposure of antibiotics contributes to the emergence of microbial resistance and increased risk of allergic reactions [14][15][16] and kidney injury [47][48][49], a single-dose regimen appears more economical and medically desirable. Moreover, the administration of long-term AMP may result in antibiotics-associated diarrhea, whose incidence varies from 10% to 30% [19,20].…”

Optimal timing of antimicrobial prophylaxis before surgery: a review of recent evidence

“…The CDC divides surgical site infections into three groups: superficial incisional SSI, deep incisional SSI, and organ/space SSI (Figure 1 (Fig. 1) ; Reference in Figure 1: Kannan et al, 2021[ 4 ]). SSIs are more commonly seen in patients with more comorbidities and patients undergoing emergency surgeries.…”

“…SSIs are more commonly seen in patients with more comorbidities and patients undergoing emergency surgeries. In addition to increased morbidity and mortality following surgery, SSI contributes to increased healthcare expenses and worsens the patient's quality of life (Kannan et al, 2021[ 4 ]). Therefore, it is crucial to prevent SSIs, thus avoiding the establishment of complications.…”

“…The appropriate antibiotic and its dose are chosen depending on the microbial flora, its complications, and patient risk factors. Kannan et al (2021[ 4 ]) had done a review to determine the sufficient number of prophylactic antimicrobial doses that are efficacious in controlling the SSIs following GI oncological surgeries. The authors concluded that single-dose antimicrobial prophylaxis had the same efficacy as the multiple-dose antimicrobial regimen in controlling SSIs in esophageal, gastric, and colorectal surgeries.…”