Is the Addition of Anaerobic Coverage to Perioperative Antibiotic Prophylaxis During Soft Tissue Sarcoma Resection Associated With a Reduction in the Proportion of Wound Complications?

Abstract

Background Wound complications are common after resection of soft tissue sarcomas, with published infection rates ranging from 10% to 35%. Multiple studies have reported on the atypical flora comprising these infections, which are often polymicrobial and contain anaerobic bacteria, and recent studies have noted the high prevalence of anaerobic bacterial infections after soft tissue sarcoma resection [26,35]. Based on this, our institution changed clinical practice to include an antibiotic with anaerobic coverage in addition to the standard first-generation cephalosporin for prophylaxis during soft tissue sarcoma resections. The current study was undertaken to evaluate whether this change was associated with a change in major wound complications, and if the change should therefore be adopted for future patients. Questions/purposes (1) After controlling for potentially confounding variables, was the broadening of the prophylactic antibiotic spectrum to cover anaerobic bacteria associated with a lower odds of major wound complications after soft tissue sarcoma resection? (2) Was the broadening of the prophylactic antibiotic spectrum to cover anaerobic bacteria associated with a lower odds of surgical Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

CORR Insights®: Is the Addition of Anaerobic Coverage to Perioperative Antibiotic Prophylaxis During Soft Tissue Sarcoma Resection Associated With a Reduction in the Proportion of Wound Complications?

“…The current study by Ramsey et al [10] found that the addition of anerobic coverage (most often metronidazole) to the standard prophylactic regimen (usually a first-generation cephalosporin) during STS resection was associated with a lower odds of major wound complications and no documented adverse reactions attributable to the additional antibiotics. The authors acknowledge that the work is preliminary, but it certainly indicates follow-up studies that can help us determine the best methods for preventing surgical site infection in patients undergoing STS resection.…”

“…Future studies should focus on this anatomic site compared with others. This may add an important variable to support the indication for the protocol suggested by Ramsay et al [10].…”

“…This may add an important variable to The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR ® or The Association of Bone and Joint Surgeons ® . M. Isler ✉, University of Montreal, Hopital Maisonneuve-Rosemont, Orthopedic Oncology Unit, 5345 Boulevard de l'Assomption, Montreal, Quebec H1T 4B3, Canada, Email: marcisler@videotron.ca support the indication for the protocol suggested by Ramsay et al [10].…”

“…The research model used in the PARITY study [9] using strict methodology combined with a large (global)-scale recruitment structure could be applied to answer the questions raised by the authors of this study [10]. In particular, what are the causative organisms in surgical site infections after STS resection, and what is the best prophylaxis?…”

“…And although the number needed to treat was only 10 (the number of patients in whom one might need to use the new antibiotic regimen to avoid one major wound complication), which suggests a potentially impactful intervention, I believe we need to tread cautiously, because this study could not exclude the possibility of uncommon but potentially severe complications with the use of additional drugs, nor the risk of causing antibiotic resistance among patients treated in the tertiary-care centers where this kind of work is usually done. Still, major wound complications are devastating, and we need to be open to alternatives such as those proposed by Ramsey et al [10].…”