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

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.

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

Updates in Surgery ◽

10.1007/s13304-021-01112-5 ◽

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.

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Understanding the role of mechanical bowel preparation and oral antibiotics prior to elective colorectal surgery

Annals of Laparoscopic and Endoscopic Surgery ◽

10.21037/ales.2019.05.01 ◽

2019 ◽

Vol 4 ◽

pp. 47-47

Author(s):

James Wei Tatt Toh ◽

Joris Harlaar ◽

Angelina Di Re ◽

Nimalan Pathmanathan ◽

Toufic El Khoury ◽

...

Keyword(s):

Colorectal Surgery ◽

Bowel Preparation ◽

Mechanical Bowel Preparation ◽

Oral Antibiotics ◽

Elective Colorectal Surgery

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ROLE OF ORAL ANTIBIOTICS IN ELECTIVE COLORECTAL SURGERY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i10.694 ◽

2019 ◽

Vol 3 (10) ◽

Author(s):

Dr. Amit Ramesh Churi

Keyword(s):

Placebo Group ◽

Colorectal Surgery ◽

Surgical Site Infection ◽

Hospital Stay ◽

Surgical Site Infections ◽

Site Infection ◽

Oral Antibiotics ◽

Elective Colorectal Surgery ◽

Medication Group ◽

Group 2

Introduction: Surgical site infection (SSI) is a major burden for patients who are posted for elective colorectal surgery, also there is significant increase to the cost of health care.it is a major cause of morbidity after surgery and is associated with increased hospital stay, readmissions, costs, and sometimes mortality. Surgical site infections are very high in colorectal surgery and are estimated to vary from 15% to 30% of patients undergoing colorectal surgery. For colorectal surgeries, orally administered antibiotics can be used in addition to the intravenous antibiotic prophylaxis. Material and Methods: A total of 46 patients were included in the study who were posted for elective colorectal surgery. Patients who start with the 3-day intervention period but for whom surgery is cancelled or postponed for more than 7 days, will not be evaluable for analysis. After enrolment, patients were randomly assigned to one of two treatment arms in a 1:1 ratio. Patients were blinded into two groups, group 1 (medication group) and group 2 (placebo group). Patients are instructed to take the medication four times daily, during the last 3 days prior to surgery. Results: There were 16 (69.6%) male and 7 (30.4%) in medication group while in placebo group male were15 (65.2%) and female were 8 (34.8%). Mean age in medication group was 46.2 ±15.24 and in placebo group was 48.2 ± 14.55. BMI (Body mass index) in medication group was 29.44 ± 3.74 and in placebo group was 28.76 ± 2.96. Operative time in group medication was 6.4±2.12 and in placebo group was 6.23 ± 1.96. This was not significant. Surgical site infection (SSI) in medication group was 3(13%) and in placebo group was 8(39%). Mean Hospital stay (days) in medication group was 13.11± 2.45 and in placebo group was 16.2±3.87, this was statistically significant. No. of antibiotics required postoperatively in medication group was .2± 1.4 and in placebo group was 6.4±2.4. Conclusion: Administration of oral antibiotics 3 days prior to colorectal surgery can significantly reduce the surgical site infection and mean hospital stay thereby reducing the morbidity. Keywords: antibiotics, colorectal surgery, SSI, MBP and BMI

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