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Techniques in Coloproctology

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01-12-2011 | Original Article

Combination of oral non-absorbable and intravenous antibiotics versus intravenous antibiotics alone in the prevention of surgical site infections after colorectal surgery: a meta-analysis of randomized controlled trials

Authors: C. F. Bellows, K. T. Mills, T. N. Kelly, G. Gagliardi

Published in: Techniques in Coloproctology | Issue 4/2011

Abstract

Background

Oral non-absorbable antibiotics work by decreasing intraluminal bacterial content after mechanical bowel preparation. The advantage of adding oral non-absorbable antibiotics to intravenous antibiotics to decrease surgical site infection (SSI) after colorectal surgery is not well known. We conducted a meta-analysis of randomized controlled trials (RCT) comparing the effectiveness of combined oral non-absorbable and intravenous antibiotics versus intravenous antibiotics alone in reducing the incidence of SSI following colorectal surgery.

Method

We included RCT comparing a combination of oral non-absorbable antibiotics and intravenous antibiotics to intravenous antibiotics alone in order to prevent SSI after colorectal surgery. Outcomes assessed included postoperative infectious complications, such as surgical wound infections (SWI) defined as a combination of superficial and deep SSI, organ-space infections and anastomotic dehiscence.

Results

Sixteen RCT published between 1979 and 2007 were included in the meta-analysis. The overall analyses indicated that patients randomly assigned to an oral non-absorbable antibiotic in addition to an intravenous antibiotic had a reduced risk of SWI (RR: 0.57 [95% CI: 0.43–0.76], p = 0.0002) compared with participants receiving only intravenous antibiotics. The use of oral non-absorbable antibiotics in addition to intravenous antibiotics had no significant effect on organ-space infections (RR: 0.71 [95% CI: 0.43–1.16], p = 0.2) or the risk of anastomotic leak (RR: 0.63 [95% CI: 0.28–1.41], p = 0.3).

Conclusion

Our meta-analysis shows that a combination of oral non-absorbable antibiotics and intravenous antibiotics significantly lowers the incidence of SWI compared with intravenous antibiotics alone. In light of our results, the use of oral non-absorbable antibiotics in colorectal surgery should be encouraged.

Kwaan M (2010) Surgical site infection in colorectal surgery: a new look at an old risk adjustment tool. Dis Colon Rectum 53:709–710PubMedCrossRef

Pastor C, Artinyan A, Varma MG, Kim E, Gibbs L, Garcia-Aguilar J (2010) An increase in compliance with the surgical care improvement project measures does not prevent surgical site infection in colorectal surgery. Dis Colon Rectum 53:24–30PubMedCrossRef

Dimick JB, Chen SL, Taheri PA, Henderson WG, Khuri SF, Campbell DA Jr (2004) Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program. J Am Coll Surg 199:531–537PubMedCrossRef

Eagye KJ, Nicolau DP (2009) Deep and organ-space infections in patients undergoing elective colorectal surgery: incidence and impact on hospital length of stay and costs. Am J Surg 198:359–367PubMedCrossRef

Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36:309–332PubMedCrossRef

Nelson RL, Glenny AM, Song F (2009) Antimicrobial prophylaxis for colorectal surgery. Cochrane Database Syst Rev 21:CD001181

Nichols RL, Condon RE (1971) Preoperative preparation of the colon. Surg Gynecol Obstet 132:323–337

Polk HC, Lopez-Mayor JF (1969) Postoperative wound infection: a prospective study of determinant factors and prevention. Surgery 66:97PubMed

Nichols RL, Broido P, Condon RE, Gorbach SL, Nyhus LM (1973) Effect of preoperative neomycin-erythromycin intestinal preparation on the incidence of infectious complications following colon surgery. Ann Surg 178:453–462PubMedCrossRef

10.

Baum ML, Anish DS, Chalmers TC, Sacks HS, Smith H Jr, Fagerstrom RM (1981) A survey of clinical trials of antibiotic prophylaxis in colon surgery: evidence against further use of no-treatment controls. N Engl J Med 305:795–799PubMedCrossRef

11.

Sterne JAC, Bradburn MJ, Egger M (2001) Meta-analysis in Stata. In: Egger M, Smith GD, Altman D (eds) Systematic reviews in health care: meta-analysis in context, 2nd edn. BMJ Publishing Group, London

12.

DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188PubMedCrossRef

13.

Hanel KC, King DW, McAllister ET, Reiss-Levy E (1980) Single-dose parenteral antibiotics as prophylaxis against wound infections in colonic operations. Dis Colon Rectum 23:98–101PubMedCrossRef

14.

Lazorthes F, Legrand G, Monrozies X et al (1982) Comparison between oral and systemic antibiotics and their combined use for the prevention of complications in colorectal surgery. Dis Colon Rectum 25:309–311PubMedCrossRef

15.

Monrozies X, Lazorthes F, Fretigny E, Chiotasso P, Massip P (1983) Evaluation of systemic antibiotic preventive treatment in colorectal surgery. J Chir 120:393–396

16.

Kaiser AB, Herrington JL Jr, Jacobs JK, Mulherin JL Jr, Roach AC, Sawyers JL (1983) Cefoxitin versus erythromycin, neomycin, and cefazolin in colorectal operations. Importance of the duration of the surgical procedure. Ann Surg 198:525–530PubMedCrossRef

17.

Peruzzo L, Savio S, De Lalla F (1987) Systemic versus systemic plus oral chemoprophylaxis in elective colorectal surgery. Chemioterapia 6:601–603PubMed

18.

Coppa GF, Eng K (1988) Factors involved in antibiotic selection in elective colon and rectal surgery. Surgery 104:853–858PubMed

19.

Lau WY, Chu KW, Poon GP, Ho KK (1988) Prophylactic antibiotics in elective colorectal surgery. Br J Surg 75:782–785PubMedCrossRef

20.

Khubchandani IT, Karamchandani M, Sheets JA, Stasik JJ, Rosen L, Riether RD (1989) Metronidazole vs. erythromycin, neomycin, and cefazolin in prophylaxis for colonic surgery. Dis Colon Rectum 32:17–20PubMedCrossRef

21.

Reynolds JR, Jones JA, Evans DF, Hardcastle JD (1989) Do preoperative oral antibiotics influence sepsis rates following elective colorectal surgery in patients receiving perioperative intravenous prophylaxis? Surg Res Commun 7:71–77

22.

Nøhr M, Andersen JC, Juul-Jensen KE (1990) Prophylactic single-dose fosfomycin and metronidazole compared with neomycin, bacitracin, metronidazole and ampicillin in elective colorectal operations. Acta Chir Scand 156:223–230PubMed

23.

Stellato TA, Danziger LH, Gordon N et al (1983) A randomized trial of oral, systemic, and oral/systemic antibiotics for prophylaxis. Ann Surg 198:525–530CrossRef

24.

Takesue Y, Yokoyama T, Akagi S et al (2000) A brief course of colon preparation with oral antibiotics. Surg Today 30:112–116PubMedCrossRef

25.

Ishida H, Yokoyama M, Nakada H, Inokuma S, Hashimoto D (2001) Impact of oral antimicrobial prophylaxis on surgical site infection and methicillin-resistant Staphylococcus aureus infection after elective colorectal surgery. Results of a prospective randomized trial. Surg Today 31:979–983PubMedCrossRef

26.

Lewis RT (2002) Oral versus systemic antibiotic prophylaxis in elective colon surgery: a randomized study and meta-analysis send a message from the 1990s. Can J Surg 45:173–180PubMed

27.

Espin-Basany E, Sanchez-Garcia JL, Lopez-Cano M et al (2005) Prospective, randomized study on antibiotic prophylaxis in colorectal surgery. Is it really necessary to use oral antibiotics? Int J Colorectal Dis 20:542–546PubMedCrossRef

28.

Kobayashi M, Mohri Y, Tonouchi H, Miki C, Nakai K, Kusunoki M, Mie Surgical Infection Research Group (2007) Randomized clinical trial comparing intravenous antimicrobial prophylaxis alone with oral and intravenous antimicrobial prophylaxis for the prevention of a surgical site infection in colorectal cancer surgery. Surg Today 37:383–388PubMedCrossRef

29.

Bratzler DW, Hunt DR (2006) The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery. Clin Infect Dis 43:322–330PubMedCrossRef

30.

Nichols RL, Smith JW, Garcia RY, Waterman RS, Holmes JWC (1997) Current practices of preoperative bowel preparation among North American colorectal surgeons. CID 24:609–619CrossRef

31.

Markell KW, Hunt BM, Charron PD et al (2010) Prophylaxis and management of wound infections after elective colorectal surgery: a survey of the American Society of Colon and Rectal Surgeons membership. J Gastrointest Surg 14:1090–1098PubMedCrossRef

32.

Bartlett JG, Condon RE, Gorbach SL, Clarke JS, Nichols RL, Ochi S (1978) veterans administration cooperative study on bowel preparation for elective colorectal operations: impact of oral antibiotic regimen on colonic flora, wound irrigation cultures and bacteriology of septic complications. Ann Surg 188:249–254PubMedCrossRef

33.

McArdle CS, Morran CG, Pettit L, Gemmell CG, Sleigh JD, Tillotson GS (1995) Value of oral antibiotic prophylaxis in colorectal surgery. Br J Surg 82:1046–1048PubMedCrossRef

34.

Taylor EW, Lindsay G (1994) Selective decontamination of the colon before elective colorectal surgery. West of Scotland Surgical Infection Study Group. World J Surg 18:926–931 discussion 931–932PubMedCrossRef

35.

Guenaga KK, Matos D, Wille-Jørgensen P (2009) Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev (1):CD001544

36.

Idkaidek NM, Najib NM (2000) Enhancement of oral absorption of metronidazole suspension in humans. Eur J Pharm Biopharm 50:213–216PubMedCrossRef

37.

Englesbe MJ, Brooks L, Kubus J et al (2010) A statewide assessment of surgical site infection following colectomy: the role of oral antibiotics. Ann Surg 252:514–519 discussion 519–520PubMed

38.

Murray BW, Huerta S, Dineen S, Anthony T (2010) Surgical site infection in colorectal surgery: a review of the non pharmacologic tools of prevention. J Am Coll Surg 211:812–822PubMedCrossRef

39.

Wick EC, Vogel JD, Church JM, Remzi F, Fazio VW (2009) Surgical site infections in a “high outlier” institution: are colorectal surgeons to blame? Dis Colon Rectum 52:374–379PubMedCrossRef

40.

Konishi T, Watanabe T, Kishimoto J, Nagawa H (2006) Elective colon and rectal surgery differ in risk factors for wound infection results of prospective surveillance. Ann Surg 244:758–763PubMedCrossRef

41.

Yamamoto S, Fujita S, Ishiguro S, Akasu T, Moriya Y (2008) Wound infection after a laparoscopic resection for colorectal cancer. Surg Today 38:618–622PubMedCrossRef

Title: Combination of oral non-absorbable and intravenous antibiotics versus intravenous antibiotics alone in the prevention of surgical site infections after colorectal surgery: a meta-analysis of randomized controlled trials
Authors: C. F. Bellows
K. T. Mills
T. N. Kelly
G. Gagliardi
Publication date: 01-12-2011
Publisher: Springer Milan
Published in: Techniques in Coloproctology / Issue 4/2011
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI: https://doi.org/10.1007/s10151-011-0714-4

At a glance: The ONWARDS insulin icodec trials

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Combination of oral non-absorbable and intravenous antibiotics versus intravenous antibiotics alone in the prevention of surgical site infections after colorectal surgery: a meta-analysis of randomized controlled trials

Abstract

Background

Method

Results

Conclusion

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Abstract

Background

Method

Results

Conclusion

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