Effect of Preoperative Selective Digestive Decontamination with Oral Gentamicin on Postoperative Infections after Esophagectomy.

OBJECTIVES

This study evaluated whether preoperative selective digestive decontamination (SDD) with oral gentamicin reduces the incidence of postoperative infections in patients undergoing oesophagectomy for oesophageal cancer.

METHODS

We conducted a retrospective cohort study of 64 patients who underwent oesophagectomy for oesophageal cancer. The primary outcome was clinically diagnosed postoperative infection. To address potential confounding and small-sample bias, a prespecified 5-variable model was fitted using Firth's penalized logistic regression. Model performance was assessed by area under the receiver operating characteristic curve (AUC), Brier score, and bootstrap-corrected calibration. Secondary outcomes included inflammatory markers, fever characteristics, antibiotic use, and perioperative recovery indicators.

RESULTS

Postoperative infections occurred in 4 of 27 (14.8%) patients in Group A and 12 of 37 (32.4%) in Group B (Fisher's exact P = .147). In the Firth model, preoperative oral gentamicin showed a non-significant trend towards lower infection risk (odds ratio [OR] 0.36, 95% confidence interval [CI], 0.09-1.28; P = .12). The model demonstrated acceptable discrimination (AUC 0.734) and good apparent calibration (Brier 0.144; calibration intercept 0, slope 1). Patients receiving gentamicin also had lower postoperative day 1 procalcitonin levels (median 0.14 vs 0.28 ng/mL; P = .009), while other inflammatory markers and recovery indicators were similar between groups.

CONCLUSIONS

Preoperative oral gentamicin-based SDD was associated with a numerically lower risk of postoperative infection and lower early inflammatory biomarkers, although the association did not reach statistical significance. Given the small sample size and single-centre design, these findings are exploratory and should be interpreted with caution. Larger multicentre randomized trials are needed to validate these preliminary observations.