Skip to main content
Top
Published in: BMC Surgery 1/2009

Open Access 01-12-2009 | Research article

Increased incidence of postoperative infections during prophylaxis with cephalothin compared to doxycycline in intestinal surgery

Authors: Gunnar Baatrup, Roy M Nilsen, Rune Svensen, Per E Akselsen

Published in: BMC Surgery | Issue 1/2009

Login to get access

Abstract

Background

The antibiotics used for prophylaxis during surgery may influence the rate of surgical site infections. Tetracyclines are attractive having a long half-life and few side effects when used in a single dose regimen. We studied the rate of surgical site infections during changing regimens of antibiotic prophylaxis in medium and major size surgery.

Methods

Prospective registration of surgical site infection following intestinal resections and hysterectomies was performed. Possible confounding procedure and patient related factors were registered. The study included 1541 procedures and 1489 controls. The registration included time periods when the regimen was changed from doxycycline to cephalothin and back again.

Results

The SSI in the colorectal department increased from 19% to 30% (p = 0.002) when doxycycline was substituted with cephalothin and decreased to 17% when we changed back to doxycycline (p = 0.005). In the gynaecology department the surgical site infection rate did not increase significantly. Subgroup analysis showed major changes in infections in rectal resections from 20% to 35% (p = 0.02) and back to 12% (p = 0.003).

Conclusion

Doxycycline combined with metronidazole, is an attractive candidate for antibiotic prophylaxis in medium and major size intestinal surgery.
Appendix
Available only for authorised users
Literature
1.
go back to reference Smith RL, Bohl JK, McElearney ST, Friel CM, Barclay MM, Sawyer RG, Foley EF: Wound infection after elective colorectal resection. Ann Surg. 2004, 239: 599-605. 10.1097/01.sla.0000124292.21605.99.CrossRefPubMedPubMedCentral Smith RL, Bohl JK, McElearney ST, Friel CM, Barclay MM, Sawyer RG, Foley EF: Wound infection after elective colorectal resection. Ann Surg. 2004, 239: 599-605. 10.1097/01.sla.0000124292.21605.99.CrossRefPubMedPubMedCentral
2.
go back to reference Kobayashi M, Mohri Y, Tonouchi H, Miki C, Nakai K, Kusunoki M: 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. 2007, 37: 383-388. 10.1007/s00595-006-3410-7.CrossRefPubMed Kobayashi M, Mohri Y, Tonouchi H, Miki C, Nakai K, Kusunoki M: 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. 2007, 37: 383-388. 10.1007/s00595-006-3410-7.CrossRefPubMed
3.
go back to reference Itani KM, Wilson SE, Awad SS, Jensen EH, Finn TS, Abramson MA: Ertapenem versus cefotetan prophylaxis in elective colorectal surgery. N Engl J Med. 2006, 355: 2640-2651. 10.1056/NEJMoa054408.CrossRefPubMed Itani KM, Wilson SE, Awad SS, Jensen EH, Finn TS, Abramson MA: Ertapenem versus cefotetan prophylaxis in elective colorectal surgery. N Engl J Med. 2006, 355: 2640-2651. 10.1056/NEJMoa054408.CrossRefPubMed
4.
go back to reference Skipper D, Karran SJ: A randomized prospective study to compare cefotetan with cefuroxime plus metronidazole as prophylaxis in elective colorectal surgery. J Hosp Infect. 1992, 21: 73-77. 10.1016/0195-6701(92)90155-F.CrossRefPubMed Skipper D, Karran SJ: A randomized prospective study to compare cefotetan with cefuroxime plus metronidazole as prophylaxis in elective colorectal surgery. J Hosp Infect. 1992, 21: 73-77. 10.1016/0195-6701(92)90155-F.CrossRefPubMed
5.
go back to reference Fujita S, Saito N, Yamada T, Takii Y, Kondo K, Ohue M, Ikeda E, Moriya Y: Randomized, multicenter trial of antibiotic prophylaxis in elective colorectal surgery: single dose vs 3 doses of a second-generation cephalosporin without metronidazole and oral antibiotics. Arch Surg. 2007, 142: 657-661. 10.1001/archsurg.142.7.657.CrossRefPubMed Fujita S, Saito N, Yamada T, Takii Y, Kondo K, Ohue M, Ikeda E, Moriya Y: Randomized, multicenter trial of antibiotic prophylaxis in elective colorectal surgery: single dose vs 3 doses of a second-generation cephalosporin without metronidazole and oral antibiotics. Arch Surg. 2007, 142: 657-661. 10.1001/archsurg.142.7.657.CrossRefPubMed
6.
go back to reference Cormio G, Di Fazio F, Lorusso F, Di Gesu G, Cacciapuoti C, Loverro G, Nappi L, Selvaggi L: Antimicrobial prophylaxis in laparotomic gynecologic surgery: a prospective randomized study comparing amoxicillin-clavulanic acid with cefazolin. J Chemother. 2002, 14: 618-622.CrossRefPubMed Cormio G, Di Fazio F, Lorusso F, Di Gesu G, Cacciapuoti C, Loverro G, Nappi L, Selvaggi L: Antimicrobial prophylaxis in laparotomic gynecologic surgery: a prospective randomized study comparing amoxicillin-clavulanic acid with cefazolin. J Chemother. 2002, 14: 618-622.CrossRefPubMed
7.
go back to reference Cormio G, Vicino M, Loizzi V, Tangari D, Selvaggi L: Antimicrobial prophylaxis in vaginal gynecologic surgery: a prospective randomized study comparing amoxicillin-clavulanic acid with cefazolin. J Chemother. 2007, 19: 193-197.CrossRefPubMed Cormio G, Vicino M, Loizzi V, Tangari D, Selvaggi L: Antimicrobial prophylaxis in vaginal gynecologic surgery: a prospective randomized study comparing amoxicillin-clavulanic acid with cefazolin. J Chemother. 2007, 19: 193-197.CrossRefPubMed
8.
go back to reference Gaynes RP, Culver DH, Horan TC, Edwards JR, Richards C, Tolson JS: Surgical site infection (SSI) rates in the United States, 1992-1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clin Infect Dis. 2001, 33 (Suppl 2): 69-77. 10.1086/321860.CrossRef Gaynes RP, Culver DH, Horan TC, Edwards JR, Richards C, Tolson JS: Surgical site infection (SSI) rates in the United States, 1992-1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clin Infect Dis. 2001, 33 (Suppl 2): 69-77. 10.1086/321860.CrossRef
9.
go back to reference Walz JM, Paterson CA, Seligowski JM, Heard SO: Surgical site infection following bowel surgery: a retrospective analysis of 1446 patients. Arch Surg. 2006, 141: 1014-1018. 10.1001/archsurg.141.10.1014.CrossRefPubMed Walz JM, Paterson CA, Seligowski JM, Heard SO: Surgical site infection following bowel surgery: a retrospective analysis of 1446 patients. Arch Surg. 2006, 141: 1014-1018. 10.1001/archsurg.141.10.1014.CrossRefPubMed
10.
go back to reference Milsom JW, Smith DL, Corman ML, Howerton RA, Yellin AE, Luke DR: Double-blind comparison of single-dose alatrofloxacin and cefotetan as prophylaxis of infection following elective colorectal surgery. Trovafloxacin Surgical Group. Am J Surg. 1998, 176 (Suppl 6A): 46-52. 10.1016/S0002-9610(98)00220-7.CrossRef Milsom JW, Smith DL, Corman ML, Howerton RA, Yellin AE, Luke DR: Double-blind comparison of single-dose alatrofloxacin and cefotetan as prophylaxis of infection following elective colorectal surgery. Trovafloxacin Surgical Group. Am J Surg. 1998, 176 (Suppl 6A): 46-52. 10.1016/S0002-9610(98)00220-7.CrossRef
11.
go back to reference Bratzler DW, Houck PM: Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Am J Surg. 2005, 189: 395-404. 10.1016/j.amjsurg.2005.01.015.CrossRefPubMed Bratzler DW, Houck PM: Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Am J Surg. 2005, 189: 395-404. 10.1016/j.amjsurg.2005.01.015.CrossRefPubMed
12.
go back to reference Bratzler DW, Houck PM, Richards C, Steele L, Dellinger EP, Fry DE, Wright C, Ma A, Carr K, Red L: Use of antimicrobial prophylaxis for major surgery: baseline results from the National Surgical Infection Prevention Project. Arch Surg. 2005, 140: 174-182. 10.1001/archsurg.140.2.174.CrossRefPubMed Bratzler DW, Houck PM, Richards C, Steele L, Dellinger EP, Fry DE, Wright C, Ma A, Carr K, Red L: Use of antimicrobial prophylaxis for major surgery: baseline results from the National Surgical Infection Prevention Project. Arch Surg. 2005, 140: 174-182. 10.1001/archsurg.140.2.174.CrossRefPubMed
13.
go back to reference McGrath DR, Leong DC, Armstrong BK, Spigelman AD: Management of colorectal cancer patients in Australia: the National Colorectal Cancer Care Survey. ANZ J Surg. 2004, 74: 55-64. 10.1046/j.1445-1433.2003.02891.x.CrossRefPubMed McGrath DR, Leong DC, Armstrong BK, Spigelman AD: Management of colorectal cancer patients in Australia: the National Colorectal Cancer Care Survey. ANZ J Surg. 2004, 74: 55-64. 10.1046/j.1445-1433.2003.02891.x.CrossRefPubMed
14.
go back to reference Salomon S, Jensen TG, Qvist N, Frimodt-Moller N, Pedersen C, Madsen H: Use of antibiotics in colorectal surgery in Denmark (article in danish). Ugeskr Laeger. 2007, 169: 920-925.PubMed Salomon S, Jensen TG, Qvist N, Frimodt-Moller N, Pedersen C, Madsen H: Use of antibiotics in colorectal surgery in Denmark (article in danish). Ugeskr Laeger. 2007, 169: 920-925.PubMed
15.
go back to reference Aoun E, El Hachem S, Abdul-Baki H, Ayyach B, Khalifeh M, Chaar H, Kanafani ZA, Kanj SS, Sharara AI: The use and abuse of antibiotics in elective colorectal surgery: the saga continues. Int J Surg. 2005, 3: 69-74. 10.1016/j.ijsu.2005.05.003.CrossRefPubMed Aoun E, El Hachem S, Abdul-Baki H, Ayyach B, Khalifeh M, Chaar H, Kanafani ZA, Kanj SS, Sharara AI: The use and abuse of antibiotics in elective colorectal surgery: the saga continues. Int J Surg. 2005, 3: 69-74. 10.1016/j.ijsu.2005.05.003.CrossRefPubMed
16.
go back to reference Hedrick TL, Heckman JA, Smith RL, Sawyer RG, Friel CM, Foley EF: Efficacy of protocol implementation on incidence of wound infection in colorectal operations. J Am Coll Surg. 2007, 205: 432-438. 10.1016/j.jamcollsurg.2007.04.042.CrossRefPubMed Hedrick TL, Heckman JA, Smith RL, Sawyer RG, Friel CM, Foley EF: Efficacy of protocol implementation on incidence of wound infection in colorectal operations. J Am Coll Surg. 2007, 205: 432-438. 10.1016/j.jamcollsurg.2007.04.042.CrossRefPubMed
17.
go back to reference Giercksky KE, Fuglesang J, Christiansen E, Johnson JA, Bergan T: Short term chemotherapeutic prophylaxis in gastrointestinal operations. Surg Gynecol Obstet. 1980, 151: 349-352.PubMed Giercksky KE, Fuglesang J, Christiansen E, Johnson JA, Bergan T: Short term chemotherapeutic prophylaxis in gastrointestinal operations. Surg Gynecol Obstet. 1980, 151: 349-352.PubMed
18.
go back to reference Dellinger EP, Gross PA, Barrett TL, Krause PJ, Martone WJ, McGowan JE, Sweet RL, Wenzel RP: Quality standard for antimicrobial prophylaxis in surgical procedures. Infectious Diseases Society of America. Clin Infect Dis. 1994, 18: 422-427.CrossRefPubMed Dellinger EP, Gross PA, Barrett TL, Krause PJ, Martone WJ, McGowan JE, Sweet RL, Wenzel RP: Quality standard for antimicrobial prophylaxis in surgical procedures. Infectious Diseases Society of America. Clin Infect Dis. 1994, 18: 422-427.CrossRefPubMed
19.
go back to reference Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG: CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control. 1992, 20: 271-274. 10.1016/S0196-6553(05)80201-9.CrossRefPubMed Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG: CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control. 1992, 20: 271-274. 10.1016/S0196-6553(05)80201-9.CrossRefPubMed
20.
go back to reference Tang R, Chen HH, Wang YL, Changchien CR, Chen JS, Hsu KC, Chiang JM, Wang JY: Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2,809 consecutive patients. Ann Surg. 2001, 234: 181-189. 10.1097/00000658-200108000-00007.CrossRefPubMedPubMedCentral Tang R, Chen HH, Wang YL, Changchien CR, Chen JS, Hsu KC, Chiang JM, Wang JY: Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2,809 consecutive patients. Ann Surg. 2001, 234: 181-189. 10.1097/00000658-200108000-00007.CrossRefPubMedPubMedCentral
21.
go back to reference Konishi T, Watanabe T, Kishimoto J, Nagawa H: Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance. Ann Surg. 2006, 244: 758-763. 10.1097/01.sla.0000219017.78611.49.CrossRefPubMedPubMedCentral Konishi T, Watanabe T, Kishimoto J, Nagawa H: Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance. Ann Surg. 2006, 244: 758-763. 10.1097/01.sla.0000219017.78611.49.CrossRefPubMedPubMedCentral
Metadata
Title
Increased incidence of postoperative infections during prophylaxis with cephalothin compared to doxycycline in intestinal surgery
Authors
Gunnar Baatrup
Roy M Nilsen
Rune Svensen
Per E Akselsen
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2009
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/1471-2482-9-17

Other articles of this Issue 1/2009

BMC Surgery 1/2009 Go to the issue