Oral Antibiotic Bowel Preparation Significantly Reduces Surgical Site Infection Rates and Readmission Rates in Elective Colorectal Surgery

Background: The role of oral antibiotic prophylaxis (OAP) and mechanical bowel preparation (MBP) in the prevention of surgical site infection (SSI) after colorectal surgery is still controversial. The aim of this study was to analyze the effect of a bundle including both measures in a National Infection Surveillance Network in Catalonia. Methods: Pragmatic cohort study to assess the effect of OAP and MBP in reducing SSI rate in 65 hospitals, comparing baseline phase (BP: 2007–2015) with implementation phase (IP: 2016–2019). To compare the results, a logistic regression model was established. Results: Out of 34,421 colorectal operations, 5180 had SSIs (15.05%). Overall SSI rate decreased from 18.81% to 11.10% in BP and IP, respectively (OR 0.539, CI95 0.507–0.573, p < 0.0001). Information about bundle implementation was complete in 61.7% of cases. In a univariate analysis, OAP and MBP were independent factors in decreasing overall SSI, with OR 0.555, CI95 0.483–0.638, and OR 0.686, CI95 0.589–0.798, respectively; and similarly, organ/space SSI (O/S-SSI) (OR 0.592, CI95 0.494–0.710, and OR 0.771, CI95 0.630–0.944, respectively). However, only OAP retained its protective effect at both levels at multivariate analyses. Conclusions: oral antibiotic prophylaxis decreased the rates of SSI and O/S-SSI in a large series of elective colorectal surgery.

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Preoperative oral antibiotic bowel preparation in elective resectional colorectal surgery reduces rates of surgical site infections: a single-centre experience with a cost-effectiveness analysis

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2019.0117 ◽

2020 ◽

Vol 102 (2) ◽

pp. 133-140 ◽

Cited By ~ 1

Author(s):

B Vadhwana ◽

A Pouzi ◽

G Surjus Kaneta ◽

V Reid ◽

D Claxton ◽

...

Keyword(s):

Length Of Stay ◽

Surgical Site Infection ◽

Bowel Preparation ◽

Mechanical Bowel Preparation ◽

Surgical Site Infections ◽

Oral Antibiotic ◽

Site Infection ◽

Infection Rates ◽

Single Centre ◽

Effectiveness Analysis

Introduction Surgical site infections cause considerable postoperative morbidity and mortality. The aim of this study was to determine the effect on surgical site infection rates following introduction of a departmental oral antibiotic bowel preparation protocol. Methods A prospective single-centre study was performed for elective colorectal resections between May 2016-April 2018; with a control group with mechanical bowel preparation and treatment group with oral antibiotic bowel preparation (neomycin and metronidazole) and mechanical bowel preparation. The primary outcome of surgical site infection and secondary outcomes of anastomotic leak, length of stay and mortality rate were analysed using Fisher’s exact test and independent samples t-tests. A cost-effectiveness analysis was also performed. Results A total of 311 patients were included; 156 in the mechanical bowel preparation group and 155 in the mechanical bowel preparation plus oral antibiotic bowel preparation group. The study included 180 (57.9%) men and 131 (42.1%) women with a mean age of 68 years. There was a significant reduction in surgical site infection rates (mechanical bowel preparation 16.0% vs mechanical bowel preparation plus oral antibiotic bowel preparation 4.5%; P = 0.001) and mean length of stay (mechanical bowel preparation 10.2 days vs mechanical bowel preparation plus oral antibiotic bowel preparation 8.2 days; P = 0.012). There was also a reduction in anastomotic leak and mortality rates. Subgroup analyses demonstrated significantly reduced surgical site infection rates in laparoscopic resections (P = 0.008). There was an estimated cost saving of £239.13 per patient and £37,065 for our institution over a one-year period. Conclusion Oral antibiotic bowel preparation is a feasible and cost-effective intervention shown to significantly reduce the rates of surgical site infection and length of stay in elective colorectal surgery.

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RETRACTED: High-concentration supplemental perioperative oxygen and surgical site infection following elective colorectal surgery for rectal cancer: a prospective, randomized, double-blind, controlled, single-site trial

The American Journal of Surgery ◽

10.1016/j.amjsurg.2014.04.002 ◽

2014 ◽

Vol 208 (5) ◽

pp. 719-726 ◽

Cited By ~ 23

Author(s):

Mario Schietroma ◽

Emanuela M. Cecilia ◽

Federico Sista ◽

Francesco Carlei ◽

Beatrice Pessia ◽

...

Keyword(s):

Rectal Cancer ◽

Colorectal Surgery ◽

Surgical Site Infection ◽

Single Site ◽

Site Infection ◽

High Concentration ◽

Double Blind ◽

Elective Colorectal Surgery

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Prospective Surveillance Effectively Reduced Rates of Surgical Site Infection Associated With Elective Colorectal Surgery at a University Hospital in Japan

Infection Control and Hospital Epidemiology ◽

10.1086/504444 ◽

2006 ◽

Vol 27 (5) ◽

pp. 526-528 ◽

Cited By ~ 12

Author(s):

Tsuyoshi Konishi ◽

Toshiaki Watanabe ◽

Keita Morikane ◽

Kazuhiko Fukatsu ◽

Joji Kitayama ◽

...

Keyword(s):

Colorectal Surgery ◽

Surgical Site Infection ◽

University Hospital ◽

Site Infection ◽

Prospective Surveillance ◽

Elective Colorectal Surgery ◽

Nationwide Surveillance ◽

Surveillance Database

At a university hospital in Japan, the introduction of prospective surveillance and subsequent interventions was effective in reducing the rate of surgical site infection associated with elective colorectal surgery from 27.5% to 17.8% of surgeries. Japan should both recognize the importance of broader surveillance for surgical site infection and establish its own nationwide surveillance database.

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