Issues Related to the Use of Antibacterial Agents in the Field of Surgery of Digestive Organs

Yoshinobu Sumiyama, Takashi Yokoyama*

The Third Department of Surgery, Toho University School of Medicine
*Department of General Medicine, Hiroshima University School of Medicine

The main target of the symposium titled "Issues related to the use of antibacterial agents in the field of surgery of digestive organs" held in the 43rd General Conference of the Japanese Society of Surgery of Digestive Organs consisted in drawing a practical conclusion on some standards for selecting the antibacterial agents by investigating the correct uses of the agents in order to prevent the incidences caused by highly resistant bacteria such as MRSA. The subjects of the discussions in the symposium had been in advance concentrated into 1) timing and 2) duration of the administration and 3) selection of the agents,and questionnaires based on these subjects had beenmailed to 953 institutions or facilities nationwide, to obtain replies from 32.4% of them. Discussions were ade on the results of the questionnaires, comments by the symposium speakers and feed-back of opinions of the whole symposium participants in the conference room colleted by the answer-checking system. 1) As for the timing of the administration of the antibacterial agents, their pre-operative administration since before the day of operation was found to be made in 76.5% of the results of the nation-wide questionnaires and in 82% of the answer-checking system at the site of conference, in which the administration was quenerally made for the cases of operation of the lower digestive organs. It was pointed out that the pre-operative administration caused more or less disturbances in the bacterial flora in the intestinal tracts, which tended to cause the emergence of highly resistive bacteria such as MRSA. The administration of the antibacterial agents during the operation was found to be made in as low as 39% in the results of the nation-wide questionnaires and in 46% of the answer-checking system at site. Including the institutions wherein the administration of the agents during the operation was already adopted, 87% of those based on the answer-checking system at site expressed their intention to do the intra-operative administration of the agents, suggesting their positive posture toward the intra-operative administration. 2) As for the duration of administration of the antibacterial agents, it was pointed out that their long-term administration maight develop emergence of resistive bacteria or bacterial alteration phenomenon. It was recommended that, as a rule, the preventive administration of the agents be kept administered for 3 or 4 consecutive days, and then, subject to identification of any sign of infection, the agents be switched into therapeutic remedies. 3) As for the selection of the antibacterial agents, it was recommended that the first-choice antibacterial agents for prevention of infection be selected exclusively aiming at control of virulent bacteria and that cephem-derivative antibiotics of the first and/or the second generations be normally administered against the bacteria aimed at in the cases of esophageal cancers and gastric cancers because the bacteria in these cases are mainly Grampositive cocci such as Staphylococcus aureus and Staphylococcus epidermis. It was also recommended in the cases of operation agsinst gall stones that the duration of the administration be once during the operation and 2-3 days in a row thereafter and cephem-derivative antibiotics of the first and the second generations can cover most of the cases including those of cysticoectomy with laparoscope and those of cholecystotomy. It was found out that 73% of. the participants based on the answer-checking system at site were of the opinion that Piperacillin or its second generation agents are sufficient for prophylaxis of possible infections in the operation of liver and pancreas. For the colon cabcer operation case, the second generation of cefem was selected as the first choice of prophylaxis agents. But in the case of sever infection, the 3rd generation of cefem or Flomoxef were also recommended to use as prophylaxis agents. It was recommended that the prophylactic agents against postoperative infection be swtched into a therapeutic agents at the after time point where symptons of infection are noted after the day of 3 from the operation. Furthermore, discussion were made especially on the diagnosis end therapies for the fungal infections among other special postoperative infections in selectiong an agents for therapy against infection with no etiological bacterium for identified.

Key words
postoperative infection, antibiotics, MRSA

Reprint requests
Yoshinobu Sumiyama The Third Department of Surgery, Toho University School of Medicine
2-17-6 Ohashi, Meguroku, Tokyo, 153 JAPAN

Accepted
July 25, 1994

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