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선택적 대장절제술 후 예방적 항생제 투여기간에 대한 전향적 다기관 무작위 대조 연구: 3일 요법과 5일 요법

A Prospective, Multicenter, Randomized Trial for Duration of the Prophylactic Antibiotics after Elective Colorectal Surgery: 3 Days versus 5 Days

대한대장항문학회지 2010년 26권 2호 p.123 ~ 128
박지원 ( Park Ji-Won ) - 국립암센터 대장암센터

전호경 ( Chun Ho-Kyung ) - 성균관대학교 의과대학 삼성서울병원 외과학교실
이우용 ( Lee Woo-Yong ) - 성균관대학교 의과대학 삼성서울병원 외과학교실
윤해란 ( Yun Hae-Ran ) - 성균관대학교 의과대학 삼성서울병원 외과학교실
손승국 ( Sohn Seung-Kook ) - 연세대학교 의과대학 외과학교실
최효성 ( Choi Hyo-Seong ) - 국립암센터 대장암센터
이강영 ( Rhee Kang-Young ) - 연세대학교 의과대학 외과학교실
오재환 ( Oh Jae-Hwan ) - 국립암센터 대장암센터
유상범 ( Yoo Sang-Bum ) - 국립암센터 대장암센터
최영주 ( Choi Young-Ju ) - 국립암센터 감염클리닉
박소희 ( Park So-Hee ) - 국립암센터 암통계연구과
김정만 ( Kim Jung-Man ) - 연세대학교 의과대학 외과학교실


Purpose: The use of prophylactic antibiotics in elective colorectal surgery is essential. Although postoperative prophylactic antibiotics are recommended within 24 hr, the optimal duration of the use of prophylactic antibiotics after colorectal surgery has not yet been fully proven in Korea. The aim of this study was to compare infectious outcomes in elective colorectal cancer surgery between postoperative 3-day antibiotic therapy and 5-day therapy.

Methods: We conducted a multicenter, randomized trial of a 3-day use vs. a 5-day use of the second-generation cephalosporin cefotetan after elective colorectal surgery. The main outcome measures were the incidences of surgical site infection and all other infectious complications within 21 days after surgery.

Results: A total of 306 patients were enrolled. Fifty-one patients were excluded because they received additional surgery or dropped out during the study. Two-hundred fifty-five patients were analyzed in this study. The two groups were similar in terms of demographics, ASA score, tumor location, tumor stage, surgical approach (conventional open vs. laparoscopy-assisted vs. robotic-assisted), and type of operation. The incidences of surgical site infection were not significantly different between the 3-day use group (4/130 or 3.1%) and the 5-day use group (3/125 or 2.4%) (P=1.000). Incidences of overall infectious diseases did not differ significantly between the two groups. Postoperatively, both groups had similar values in their white blood cell count, absolute neutrophil count, and C-reactive protein levels. However, the number of patients is small to draw a definite conclusion in this study.

Conclusion: Three-day cefotetan administration may be not inferior in preventing surgical site infection compared to 5-day antibiotic administration. However, further studies with a large number of patients are needed before a definite conclusion can be drawn.


예방적 항생제;대장 수술
Antibiotics prophylaxis;Colorectal surgery
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