The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery

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.

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Role of Mechanical Bowel Preparation for Elective Colorectal Surgery

Korean Journal of Gastroenterology ◽

10.4166/kjg.2020.75.2.79 ◽

2020 ◽

Vol 75 (2) ◽

pp. 79

Author(s):

Ik Yong Kim

Keyword(s):

Colorectal Surgery ◽

Bowel Preparation ◽

Mechanical Bowel Preparation ◽

Elective Colorectal Surgery

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

World Journal of Gastrointestinal Surgery ◽

10.4240/wjgs.v9.i12.246 ◽

2017 ◽

Vol 9 (12) ◽

pp. 246-255 ◽

Cited By ~ 3

Author(s):

Shamir O Cawich ◽

Sachin Teelucksingh ◽

Samara Hassranah ◽

Vijay Naraynsingh

Keyword(s):

Colorectal Surgery ◽

Surgical Site Infections ◽

Oral Antibiotics ◽

Elective Colorectal Surgery

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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

Austin Journal of Clinical Case Reports ◽

10.26420/austinjclincaserep.2021.1211 ◽

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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