cefotaxime and Stomach-Neoplasms

The aim of this study was to examine the effect of decontamination as compared to placebo medication on post-gastrectomy treatment costs. The results of a prospective double-blind placebo-controlled multicenter trial indicate that perioperative i.v. prophylaxis with cefotaxim and topical decontamination with polymyxin B, tobramycin, vancomycin and amphotericin B from the day before surgery until the 7th postoperative day is most effective in the prevention of esophagojejunal anastomotic leakage following total gastrectomy. For the cost analysis, only patients who had been decontaminated according to the study protocol (n = 90) were compared to the non-decontaminated patients (n = 103). The esophagojejunal leakage rate was 10.6% in placebo patients (n = 103) and could be reduced significantly to 1.1% in decontaminated patients (n = 90, P = 0.0061; two-tailed Fisher's exact test). There was only one asymptomatic leakage detected on Gastrografin swallow. The pulmonary infection (P = 0.0173) and overall complication rates (p = 0.0238) were significantly reduced in the decontamination group as well. During the observation period, 9 (8.7%) patients in the placebo group and 3 (3.3%) in the decontaminated group died (P = n.s.). Patients were followed up for the initial 42 postoperative days and treatment costs were calculated for this time period only. The parameters compiled in the study pertaining to use of medical resources formed the basis for the determination of the postoperative treatment costs. These were the costs for decontaminating drugs, intravenous antibiotics, reoperations and non-surgical reinterventions as well as daily treatment costs of the general ward, the intensive care unit (ICU) and rehabilitation. The average costs per patient in the placebo group amounted to DM 20,000 while the costs for decontaminated patients were only DM 16,200, which was due to a significantly lower number of patients requiring treatment in the ICU (P = 0.0082), significantly fewer patients requiring i.v. antibiotics (P = 0.0232) and fewer patients with reoperations (P = 0.0909). The prophylaxis employing decontaminating drugs in the amount of DM 400 lowered post-gastrectomy treatment costs by DM 3800 or 19%. The prophylaxis can be recommended, because it lowers morbidity, mortality and the costs of total gastrectomy.

Topics: Aged; Amphotericin B; Antibiotic Prophylaxis; Cefotaxime; Cost Savings; Double-Blind Method; Drug Therapy, Combination; Female; Gastrectomy; Humans; Male; Middle Aged; Polymyxin B; Prospective Studies; Stomach Neoplasms; Surgical Wound Dehiscence; Surgical Wound Infection; Survival Rate; Tobramycin; Vancomycin

Topics: Bacteria; Biliary Tract Diseases; Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Humans; Postoperative Complications; Stomach Diseases; Stomach Neoplasms; Surgical Wound Infection

A 52-year-old man with a gastric signet-ring cell carcinoma but without acute symptoms was admitted for reconstructive surgery of the gastrointestinal tract.. Before the present surgery all functional and radiological tests merely confirmed the previously known disease. Except for mild anemia and abnormal electrolytes all laboratory tests were within normal limits. COURSE, DIAGNOSIS AND TREATMENT: The patient underwent reconstructive surgery of the gastrointestinal tract, namely an ascending sigmoidostomy and resection of an enterocutaneous fistula. For a few days the postoperative development was as expected and the drain, placed during surgery, was removed at the expected time. 9 days postoperatively the patient developed signs of an infection (fever up to 38.8 degrees C, increased WBC and raised C-reactive protein levels). Computed tomography (CT) of the abdomen revealed an epigastric tumor measuring 6 x 5 cm. CT-guided needle aspiration of this lesion showed macroscopic signs of an infected hematoma. A pigtail catheter was successfully implanted for continuous drainage. Both the fluids obtained from CT-guided aspiration and the pigtail drain grew Aeromonas veronii biovar sobria when cultured on standard blood agar. Administration of both cefotaxim and metronidazole for 10 days produced a decrease in the inflammatory parameters. The abdominal CT at that time showed a noticeable regression of the epigastric mass so that the patient was discharged from hospital 3 weeks after surgery.. This case emphasizes the importance of adequately dosed antibiotic therapy, also for unusual bacteria such as species of Aeromonas.

Topics: Aeromonas; Anti-Bacterial Agents; Carcinoma, Signet Ring Cell; Cefotaxime; Gram-Negative Bacterial Infections; Hematoma; Humans; Male; Metronidazole; Middle Aged; Postoperative Complications; Stomach Diseases; Stomach Neoplasms; Treatment Outcome

Comparative study of prophylaxis with cefotiam (CTM) was carried out in 47 patients undergoing surgery for gastric cancer. The patients were randomized in 2 treatment groups. The first group A received a single intravenous drip dose of 0.5 g CTM, given 4 times daily for 5 days after surgery. The second group B received a single intravenous drip dose of 1 g CTM, given twice daily for 5 days. Postoperative infections occurred in 8.7% (2/23) of the patients receiving CTM in group A, and in group B 8.3% (2/24). The number of infections was similar in both groups of patients. Prophylactic efficacy of CTM has also been evaluated in fever index of A and B groups. Fever index was 16.36 +/- 4.00 degree hours in A group, and in B group 7.91 +/- 2.30 degree hours, respectively. The difference between the 2 groups are statistically significant tendency. A single dose of 1 g CTM, given twice daily for 5 days, provide effective prophylaxis against infections in patients undergoing surgery for gastric cancer. CTM can be recommended for surgical prophylaxis.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Humans; Infusions, Parenteral; Middle Aged; Stomach Neoplasms; Surgical Wound Infection