Three-day postoperative antibiotics reduces post-hepatectomy infection rate in hepatitis B virus-related hepatocellular carcinoma
Three-day postoperative antibiotics reduces post-hepatectomy infection rate in hepatitis B virus-related hepatocellular carcinoma
复制标题
术后三天抗生素可降低乙型肝炎病毒相关肝细胞癌肝切除术后感染率
DOI：
10.1111/jgh.15528
复制
发表时间：
2021-05-21
影响因子：
4.1
通讯作者：
Kuang, Ming
中科院分区：
文献类型：
--
作者：
Chen, Zebin;Jiang, Hong;Kuang, Ming
背景与目的肝细胞癌（HCC）切除术患者术后抗生素（POA）使用的证据存在争议。我们旨在探讨乙型肝炎病毒（HBV）相关HCC人群中POA与肝切除术相关感染的关系。方法回顾性收集国内三所三级医院934例肝癌患者行肝切除术。记录并计算术后感染发生率，包括手术部位感染和远处部位感染。采用单变量和多变量logistic回归分析，探讨术后感染与POA的相关因素。并探讨不同POA时间与感染率的关系。结果总感染率为8.2%(77/934)，其中手术部位感染6.5%(61/934)，远处部位感染2.0%（19/934）。多变量分析显示，POA给药与术后感染发生率呈显著负相关（优势比= 0.50,95%可信区间= 0.30 ~ 0.83;P = 0.008）。白蛋白-胆红素评分、巴塞罗那临床肝癌（BCLC）分期和肝切除术程度与POA独立相关。3天方案似乎是POA持续时间最短，术后感染发生率最低的方案。结论hbv相关性HCC患者术后抗生素是预防术后感染的必要药物，特别是对于白蛋白-胆红素评分较高、BCLC B-C期或行大肝切除术的患者。对于hbv相关的HCC患者，术后使用第二代头孢菌素或头孢曲松治疗3天可能是合适的。
Background and Aim The evidences for use of postoperative antibiotics (POA) in hepatocellular carcinoma (HCC) patients who underwent hepatectomy are controversial. We aimed to explore the relationship between POA and hepatectomy-related infection in a hepatitis B virus (HBV)-related HCC population.Methods We retrospectively collected 934 HCC patients who underwent hepatectomy for curative intent from three tertiary hospitals in China. The incidences of postoperative infection including surgical site infection and remote site infection were recorded and calculated. Univariable and multivariable logistic regression analyses were performed to explore related factors of postoperative infection and POA. And the relationship between infection rates with different durations of POA was investigated.Results The overall infection rate was 8.2% (77/934), including 6.5% (61/934) of surgical site infection and 2.0% (19/934) of remote site infection. Multivariable analysis revealed that the administration of POA was negatively related with the incidence of postoperative infection significantly (odds ratio = 0.50, 95% confidence interval = 0.30 to 0.83; P = 0.008). Albumin-bilirubin score, Barcelona Clinic Liver Cancer (BCLC) stage and extent of hepatectomy were independently related to the POA. And 3-day regimen seemed to be the shortest duration of POA to gain the lowest incidence of postoperative infection.Conclusions Postoperative antibiotic is necessary for HBV-related HCC patients to prevent postoperative infection, especially for those with higher albumin-bilirubin score, at BCLC stage B-C, or who underwent major hepatectomy. For HBV-related HCC patients, postoperative second-generation cephalosporins, or ceftriaxone for 3 days after surgery might be proper.