scholarly journals Oral Antibiotic Prophylaxis Reduces Surgical Site Infection and Anastomotic Leakage in Patients Undergoing Colorectal Cancer Surgery

Biomedicines ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1184
Author(s):  
Simran Grewal ◽  
J. Reinder D. Reuvers ◽  
Gabor S. A. Abis ◽  
René H. J. Otten ◽  
Geert Kazemier ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Anastomotic Leakage ◽  
Broad Spectrum ◽  
Mechanical Bowel Preparation ◽  
Selective Decontamination ◽  
Oral Antibiotic ◽  
Site Infection ◽  
Oral Antibiotics ◽  
Colorectal Cancer Surgery ◽  
The Impact

Background: Surgical-site infection (SSI) and anastomotic leakage (AL) are major complications following surgical resection of colorectal carcinoma (CRC). The beneficial effect of prophylactic oral antibiotics (OABs) on AL in particular is inconsistent. We investigated the impact of OABs on AL rates and on SSI. Methods: A systematic review and meta-analysis of recent RCTs and cohort studies was performed including patients undergoing elective CRC surgery, receiving OABs with or without mechanical bowel preparation (MBP). Primary outcomes were rates of SSI and AL. Secondarily, rates of SSI and AL were compared in broad-spectrum OABs and selective OABs (selective decontamination of the digestive tract (SDD)) subgroups. Results: Eight studies (seven RCTs and one cohort study) with a total of 2497 patients were included. Oral antibiotics combined with MBP was associated with a significant reduction in SSI (RR = 0.46, 95% confidence interval (CI) 0.31–0.69), I2 = 1.03%) and AL rates (RR = 0.58, 95% CI 0.37–0.91, I2 = 0.00%), compared to MBP alone. A subgroup analysis demonstrated that SDD resulted in a significant reduction in AL rates compared to broad-spectrum OABs (RR = 0.52, 95% CI 0.30 to 0.91), I2 = 0.00%). Conclusion: OABs in addition to MBP reduces SSI and AL rates in patients undergoing elective CRC surgery and, more specifically, SDD appears to be more effective compared to broad-spectrum OABs in reducing AL.

scholarly journals IMPACT OF ORAL ANTIBIOTIC PROPHYLAXIS ON SURGICAL SITE INFECTION AFTER RECTAL SURGERY: RANDOMIZED CONTROLLED TRIAL

2019 ◽  
Vol 18 (1) ◽  
pp. 74-81
Author(s):  
Yu. A. Shelygin ◽  
M. A. Nagudov ◽  
A. A. Ponomarenko ◽  
E. G. Rybakov ◽  
M. A. Suhina
Keyword(s):  
Surgical Site Infection ◽  
Anastomotic Leakage ◽  
Controlled Trial ◽  
Rectal Surgery ◽  
Generation Cephalosporin ◽  
Control Group ◽  
Oral Antibiotic ◽  
Site Infection ◽  
Oral Antibiotics ◽  
Bowel Cleansing

AIM: to evaluate the efficacy of preoperative oral antibiotics in reduction of surgical site infection (SSI) in rectal surgery. METHODS: patients undergoing rectal resection were assigned randomly to 2 groups: control (standard preoperative care and intravenous injection of 3d generation cephalosporin) and oral antibiotics group (the above was complemented by three-knit oral metronidazole 500 mg and erythromycin 500 mg after beginning of mechanical bowel cleansing at 5.00, 8.00 and 10.00 p.m.). The primary endpoint was the overall rate of SSI. RESULTS: between November 2017 and October 2018, 104 patients (48 in the oral antibiotics group and 56 in control group) were enrolled for this study. The incidence of SSIs was 19.6% (11/56) in control group and 4.1% (2/48) in the oral antibiotics group(р=0.01). Both groups had no statistically significant differences in intensity of SSIs and rate of anastomotic leakage. CONCLUSION: preoperative oral antibiotic significantly reduced the risk of SSIs following rectal surgery. The study needs to be continued for evaluation of preoperative oral antibiotics impact to intensity of SSIs and rate of anastomotic leakage.

Clinical impact of obesity-related factors in perioperative management of esophageal cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 39-39
Author(s):  
HIROYA TAKEUCHI ◽  
Yuji Kikuchi ◽  
Hirofumi Kawakubo ◽  
Koichi Suda ◽  
Yuko Kitagawa
Keyword(s):  
Esophageal Cancer ◽  
Surgical Site Infection ◽  
Anastomotic Leakage ◽  
The Body ◽  
Obese Patients ◽  
Site Infection ◽  
Related Factors ◽  
Significant Difference ◽  
The Impact ◽  
High Bmi

39 Background: Obese patients with esophageal cancer have been increasing worldwide. However, the impact of obesity on esophagectomy still remains controversial. In this study, we clarified the relations between obesity and postoperative outcomes after esophagectomy in patients with esophageal cancer. Methods: A total of 215 patients who underwent esophagectomy for esophageal cancer between 2008 and 2014 were retrospectively assessed. We qualified the body mass index (BMI), visceral fat area (VFA) and subcutaneous fat area (SFA) using CYNAPSE VINCENT™. Clincopathological factors, postoperative morbidity, and survival after esophagectomy were assessed with these obesity-related factors. Results: The mean BMI, VFA, and SFA were 22.0 kg/m², 83.0cm², and 87.3cm². BMI, VFA and SFA were significantly correlated each other (P < 0.001). The prevalence of diabetes mellitus and hypertension were significantly more in high SFA than normal SFA (20% vs 10%, 30% vs 14%). When the patients were divided to two groups according to BMI (< 25 or ≥25kg/m²), VFA ( < 100 or ≥100cm²) and SFA ( < 100 or ≥100cm²), operative time was significantly longer in high SFA (P = 0.03) than normal SFA, and tended to be longer in high BMI, but blood loss were similar in each groups. Maximum level of postoperative CRP was significantly higher in high BMI (P < 0.001), in high VFA (P < 0.001), and in high SFA (P < 0.001). Length of systemic inflammatory response syndrome was significantly longer in high BMI than normal BMI (1.9 days vs 1.4 days P = 0.04), and length of ventilator support was significantly longer in high SFA than normal SFA (3.0 days vs 2.2 days P = 0.006). The incidence of anastomotic leakage and surgical site infection were significantly higher in high SFA than normal SFA (27% vs 10%, 37% vs 19%). There were no significant difference in overall survival, however, patients in high VFA tended to be longer survival than those in normal VFA (P = 0.078). Conclusions: Anastomotic leakage and surgical site infection occurred more frequently in high SFA. It might be useful to examine SFA preoperatively in obese patients with esophageal cancer for prevention of postoperative complications. Patients in high VFA tended to be longer survival than those in normal VFA.

scholarly journals Interventions to reduce the incidence of surgical site infection in colorectal resections: systematic review with multicomponent network meta-analysis (INTRISSI): study protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e057226
Author(s):  
Juliane Friedrichs ◽  
Svenja Seide ◽  
Johannes Vey ◽  
Samuel Zimmermann ◽  
Julia Hardt ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Bowel Preparation ◽  
Meta Analysis ◽  
Mechanical Bowel Preparation ◽  
Supervised Machine Learning ◽  
Controlled Trials ◽  
Site Infection ◽  
Oral Antibiotics ◽  
Colorectal Resections

ObjectiveTo assess the relative contribution of intravenous antibiotic prophylaxis, mechanical bowel preparation, oral antibiotic prophylaxis, and combinations thereof towards the reduction of surgical site infection (SSI) incidence in elective colorectal resections.Methods and analysisA systematic search of randomised controlled trials comparing interventions to reduce SSI incidence will be conducted with predefined search terms in the following databases: MEDLINE, LILACS, Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews (CDSR). Additionally, several online databases will be searched for ongoing trials, and conference proceedings and reference lists of retrieved articles will be hand searched. The title–abstract screening will be partly performed by means of a semiautomated supervised machine learning approach, which will be trained on a subset of the identified titles and abstracts identified through traditional screening methods.The primary analysis will be a multicomponent network meta-analysis, as we expect to identify studies that investigate combinations of interventions (eg, mechanical bowel preparation combined with oral antibiotics) as well as studies that focus on individual components (mechanical bowel preparation or oral antibiotics). By means of a multicomponent network meta-analysis, we aim at estimating the effects of the separate components along the effects of the observed combinations. To account for between-trial heterogeneity, a random-effect approach will be combined with inverse variance weighting for estimation of the treatment effects. Associated 95% CIs will be calculated as well as the ranking for each component in the network using P scores. Results will be visualised by network graphics and forest plots of the overall pairwise effect estimates. Comparison-adjusted funnel plots will be used to assess publication bias.Ethics and disseminationEthical approval by the Ethical Committee of the Medical Faculty of the Martin-Luther-University Halle-Wittenberg (ID of approval: 2021–148). Results shall be disseminated directly to decision-makers (eg, surgeons, gastroenterologists, wound care specialists) by means of publication in peer-reviewed journals, presentation at conferences and through the media (eg, radio, TV, etc).PROSPERO registration numberCRD42021267322.

scholarly journals Prolonged postoperative ileus after elective colorectal cancer surgery

2018 ◽  
Vol 75 (8) ◽  
pp. 780-786
Author(s):  
Milica Nestorovic ◽  
Goran Stanojevic ◽  
Branko Brankovic ◽  
Vanja Pecic ◽  
Ljiljana Jeremic
Keyword(s):  
Prospective Study ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Anastomotic Leakage ◽  
Postoperative Ileus ◽  
Length Of Hospital Stay ◽  
Site Infection ◽  
Significant Difference ◽  
Prolonged Postoperative Ileus ◽  
The Impact

Background/Aim. Postoperative ileus is a frequent and frustrating occurence for both, patients and surgeons after abdominal surgery. Besides clinical importance of postoperative ileus, its economic aspect is also important. The aim of this prospective study was to analyze development of prolonged postoperative ileus after elective colorectal surgery for cancer and its impact on early postoperative outcome. Methods. This prospective study included all eligible patients, 18 years or older, scheduled for open colorectal resection for cancer from June, 2015 to February, 2016. Patients with metastatic disease, prior hemoirradiation or any resection other then curative were excluded. The study duration was up to 30 days postoperatively. Primary outcome measure was development of prolonged postoperative ileus according to strict definition. The impact of prolonged postoperative ileus on other outcome measures such as postoperative complications, surgical site infections, anastomotic leakage, reoperations, mortality and length of hospital stay were of great interest, too. Results. This prospective study included 103 patients, 64 (37.9%) men and 39 (62.1%) women, mean age 66 years. Prolonged postoperative ileus developed in 12 (11.3%) patients. One third of the patients had some type of surgical site infection, while 47.6% had complications. Ten (9.7%) patients required reoperation. Comparing the group of patients with prolonged postoperative ileus with those without, there were no statistically significant differences in rates of surgical site infection and anastomotic leakage. There was statistically significant difference in terms of complications (_2 = 34.966; p < 0.001), complications grade III (_2 = 23.43; p < 0.001) and reoperations (_2 = 15.724; p <0.001). Patients who developed prolonged postoperative ileus had statistically significant longer postoperative hospital stay (Z = 2.291, p = 0.022) and longer total length of hospital stay (Z = 2.377, p = 0.015). According to regression analyzes prolonged postoperative ileus represents a risk factor for reoperations [odds ratio (OR) = 12.286; p = 0.001]. Conclusion. Prolonged postoperative ileus, although not life-threatening complication effects recovery, increases length of hospital stay and contributes to poor surgical outcome.

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