食管癌围手术期预防性使用抗菌药物的现状及证据

Current Status and Evidence-based Evaluation of Antibiotic Prophylaxis in Perioperative Period for Esophageal Cancer

美国和世界卫生组织最新颁布的指南均不推荐术后延长预防性使用抗菌药物的疗程,但术后预防性使用抗菌药物疗程过长是普遍存在的问题。尤其是手术难度大,术后并发症风险高的手术,术后超疗程预防性使用抗菌药物的现象更为普遍。该文以食管癌手术为例,基于我国国情,应用循证理念,深入研究食管癌围手术期抗菌药物使用的现有证据,分析可行性及困难。证据分析显示:没有证据支撑食管癌术后延长抗菌药物的使用疗程可以降低术后感染的发生率。预防手术部位感染需多管齐下,不应过度依赖抗菌药物。

Prolonged the course of prophylactic use of antibiotics after surgery was not recommend by WHO and the US Centers for Disease Control and Prevention.But a long course of antibiotic treatment to prevent surgical site infection after surgery is a common problem. In particular, the prophylactic use of antibacterials beyond the course of postoperative treatment is more common in the operation with great difficulty and high risk of postoperative complications.Taking esophageal cancer surgery as an example, based on our national conditions, this paper applied the evidence-based concept to deeply study the existing evidence of antimicrobial use in perioperative period of esophageal cancer, and analyze the feasibility and difficulties.Evidence analysis shows that there is no evidence that prolonged use of antibiotics after esophageal cancer surgery could reduce the incidence of postoperative infection.Preventing surgical site infections requires a multi-pronged approach and should not be overly dependent on on antibiotics.