scholarly journals Oral neomycin and bacitracin are effective in preventing surgical site infections in elective colorectal surgery: a multicentre, randomized, parallel, single-blinded trial (COLORAL-1)

2021 ◽  
Author(s):  
Alberto Arezzo ◽  
Massimiliano Mistrangelo ◽  
Marco Augusto Bonino ◽  
Paola Salusso ◽  
Edoardo Forcignanò ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Anastomotic Leak ◽  
Multivariable Analysis ◽  
Mechanical Bowel Preparation ◽  
Surgical Site Infections ◽  
Oral Antibiotic ◽  
Beta Lactam ◽  
Elective Colorectal Surgery ◽  
Intravenous Antibiotics

AbstractSeveral regimens of oral and intravenous antibiotics (OIVA) have been proposed with contradicting results, and the role of mechanical bowel preparation (MBP) is still controversial. This study aims to assess the effectiveness of oral antibiotic prophylaxis in preventing Surgical Site Infections (SSI) in elective colorectal surgery. In a multicentre trial, we randomized patients undergoing elective colorectal resection surgery, comparing the effectiveness of OIVA versus intravenous antibiotics (IVA) regimens to prevent SSI as the primary outcome (NCT04438655). In addition to intravenous Amoxicillin/Clavulanic, patients in the OIVA group received Oral Neomycin and Bacitracin 24 h before surgery. MBP was administered according to local habits which were not changed for the study. The trial was terminated during the COVID-19 pandemic, as many centers failed to participate as well as the pandemic changed the rules for engaging patients. Two-hundred and four patients were enrolled (100 in the OIVA and 104 in the IVA group); 3 SSIs (3.4%) were registered in the OIVA and 14 (14.4%) in the IVA group (p = 0.010). No difference was observed in terms of anastomotic leak. Multivariable analysis indicated that OIVA reduced the rate of SSI (OR 0.21 / 95% CI 0.06–0.78 / p = 0.019), while BMI is a risk factor of SSI (OR 1.15 / 95% CI 1.01–1.30 p = 0.039). Subgroup analysis indicated that 0/22 patients who underwent OIVA/MBP + vs 13/77 IVA/MBP- experienced an SSI (p = 0.037). The early termination of the study prevents any conclusion regarding the interpretation of the data. Nonetheless, Oral Neomycin/Bacitracin and intravenous beta-lactam/beta-lactamases inhibitors seem to reduce SSI after colorectal resections, although not affecting the anastomotic leak in this trial. The role of MBP requires more investigation.

scholarly journals EP.TH.965Use of Oral Antibiotics as Adjunct to Systemic Antibiotics and Mechanical Bowel Preparation for Left Sided Colorectal Surgery. It is the time to trust the best available evidence and change the practice

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shahin Hajibandeh ◽  
Shahab Hajibandeh ◽  
Christopher Thompson ◽  
Vijay Thumbe ◽  
Andrew Torrance ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Anastomotic Leak ◽  
Bowel Preparation ◽  
Mechanical Bowel Preparation ◽  
Surgical Site Infections ◽  
Oral Antibiotics ◽  
Intravenous Antibiotics ◽  
Clinically Significant ◽  
The Uk ◽  
Systemic Antibiotics

Abstract Aims To prospectively evaluate the clinical efficacy of oral antibiotics as an adjunct to intravenous antibiotics and mechanical bowel preparation (MBP) in patients undergoing left sided colorectal surgery. Methods All participants aged 18 years or older and of any gender undergoing an elective open or laparoscopic left sided colorectal resection for benign or malignant colorectal pathologies were considered. The intervention of interest was oral neomycin 1g every 4 hours combined with oral metronidazole 400mg every 8 hours from 24 hours before the proposed surgery. Surgical site infections (SSIs), anastomotic leak, paralytic ileus, need for intervention, and mortality were the evaluated outcome parameters. Results Forty-two consecutive patients received oral antibiotics as an adjunct to intravenous antibiotics and MBP before left sided colorectal surgery. The mean age was 58.8 ± 11.5. There were 23 males (54.8%) and 19 females (45.2%). Use of oral antibiotics was associated with SSI infection rate of 2.4% (1 patient). The rates of clinically significant and non-significant anastomotic leak were 0% and 2.9%, respectively. Moreover, postoperative ileus happened in 11.9% of patients. Furthermore, there was no mortality or need for re-intervention. Conclusions Use of oral antibiotics as an adjunct to intravenous antibiotics and MBP in patients undergoing left-sided colorectal surgery was associated with a surprisingly low rate of SSIs and no significant anastomotic leak. It is time to trust the best available evidence and incorporate the use of oral antibiotics as an adjunct to intravenous antibiotics and MBP in colorectal surgery protocols in the UK hospitals.

scholarly journals 1146 Use of Prophylactic Oral Antibiotics in Preventing Postoperative Surgical Site Infections in Elective Colorectal Surgery – A Review

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Arumuga Jothi
Keyword(s):  
Colorectal Surgery ◽  
Antibiotic Prophylaxis ◽  
English Language ◽  
Adult Population ◽  
Mechanical Bowel Preparation ◽  
Surgical Site Infections ◽  
Oral Antibiotic ◽  
Oral Antibiotics ◽  
Elective Colorectal Surgery ◽  
Randomised Controlled

Abstract Aim To prevent postoperative surgical site infections (SSIs), prophylactic oral antibiotics (OA) administration in combination with mechanical bowel preparation (MBP) and prophylactic parenteral (IV) antibiotics have been a preoperative procedure in elective colorectal surgery. Hence, the aim of this article is to review the effectiveness of prophylactic OA in preventing SSIs in elective colorectal surgery. Method PubMed and Scopus databases were searched. Search criteria included keywords such as antibiotic prophylaxis, oral antibiotic prophylaxis, parenteral antibiotic prophylaxis, postoperative surgical site infection and colorectal surgery. Selection criteria included any randomised controlled trials (RCTs) which investigated the effectiveness of prophylactic OA, with or without prophylactic IV antibiotics in preventing SSIs in elective colorectal surgery in adult population, published from the years 2010 onwards. Only full text studies and papers published in English language were chosen. Results Ten RCTs were included in this study. Studies indicated that OA alone could significantly reduce the risk of postoperative SSIs (p < 0.05). Further analysis of these studies showed that in the presence of IV antibiotic prophylaxis, there is an even greater reduction in the risk of SSIs (P < 0.05). However, an article by Hjalmarsson et al. showed that there was a significantly greater rate of incisional SSIs in prophylactic OA group in comparison to prophylactic IV antibiotics group (P < 0.022). Conclusions These studies indicate that OA in combination with IV antibiotic prophylaxis is superior to either IV antibiotic prophylaxis or OA prophylaxis respectively. Hence, it is advisable to administer a combined OA and IV antibiotic prophylaxis in elective colorectal surgery.

scholarly journals The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery

2019 ◽  
Vol 270 (1) ◽  
pp. 43-58 ◽  
Author(s):  
Katie E. Rollins ◽  
Hannah Javanmard-Emamghissi ◽  
Austin G. Acheson ◽  
Dileep N. Lobo
Keyword(s):  
Colorectal Surgery ◽  
Oral Antibiotic ◽  
Elective Colorectal Surgery

scholarly journals Role of oral antibiotics for prophylaxis against surgical site infections after elective colorectal surgery

2017 ◽  
Vol 9 (12) ◽  
pp. 246-255 ◽  
Author(s):  
Shamir O Cawich ◽  
Sachin Teelucksingh ◽  
Samara Hassranah ◽  
Vijay Naraynsingh
Keyword(s):  
Colorectal Surgery ◽  
Surgical Site Infections ◽  
Oral Antibiotics ◽  
Elective Colorectal Surgery

scholarly journals Another Brick in the Wall of an Ongoing Discussion– Reduction of Anastomotic Leaks after Colorectal Resection by Preoperative Mechanical Bowel Preparation in Combination with Oral and Parenteral Antibiotics?–A Clinical Retrospective Single Center Study

2021 ◽  
Vol 8 (5) ◽  
Author(s):  
Safia O ◽  
◽  
Kuebler S ◽  
Mall JW ◽  
Tallbot SR ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Bowel Preparation ◽  
Elective Surgery ◽  
Mechanical Bowel Preparation ◽  
Oral Antibiotic ◽  
Single Center ◽  
Elective Colorectal Surgery ◽  
Single Center Study ◽  
Center Study

Background: In colorectal surgery, postoperative Anastomotic Leak (AL) is a serious complication. Besides the surgeon`s experience, bowel preparation may have an impact on AL, but the published data are still inconclusive. The purpose of this retrospective single center study was to investigate the role of preoperative Mechanical Bowel Preparation (MBP) in combination with Oral Antibiotic Bowel Preparation (OBP) and parenteral antibiotics in a certified highvolume colorectal center. Methods: In the period of January 2017 to December 2019, all colon and rectal surgeries were recorded and separated into emergency and elective surgeries. Patients in the elective surgery group were further divided into two groups: patients with Bowel Preparation (BP) and patients without BP and were evaluated concerning to AL, postoperative hospital length of stay and mortality. Results: Between 2017 to 2019, 625 patients underwent colorectal surgery. 262 patients had emergency operations and were therefore excluded from the study. 363 patients underwent colorectal elective surgery (197men, 166 women). 44.0% received Combined Bowel Preparation (CBP), 46.8% received no BP, 3.3% received OBP only, 4.1% received MBP only, and for 1.1% nothing was documented. CBP was not only associated with a reduction in the rate of AL (P=0.038) (14.1% vs. 4.4%), but also with reduction in mortality (P=0.032) (7.6% vs. 1.2%) and length of stay (P=0.016) (14 vs. 11 days). Conclusion: Our retrospective data showed a significant impact of preoperative intestinal preparation with MBP in combination with OBP and parenteral antibiotics on AL, length of stay and mortality. Therefore we strongly recommend the use of this regimen of preoperative BP in elective colorectal surgery.

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