Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomised controlled trials.

Abstract

This review evaluates the relative efficacy of antimicrobial prophylaxis in patients undergoing colorectal surgery where there is a high risk of surgical wound infection (SWI). Methods Data sources Literature searches of Medline, Embase and the Cochrane Controlled Trials Register were conducted to identify randomised controlled trials (RCTs) published between 1984 and 1995, which investigated antimicrobial prophylaxis in the prevention of postoperative wound infection in patients who had undergone colorectal surgery. Bibliographies of reviews and all identified trials were examined to locate additional studies. A sample of key journals was also handsearched. All languages were considered. Copies State how the article was located, e.g. name the database, handsearching. If an article is to have more than one record, only the first record should list the method of location, for any further records enter Repeat.

Preventing surgical-site infections after colorectal surgery

“…Hence, colorectal surgery might have a higher risk for SSI development. Furthermore, although intraoperative redosing is generally recommended only when the operation lasts longer than 2-3 h, Song and Glenny [33] showed a single-dose or short-term regimen is as effective as longterm postoperative administration and that no significant difference in the incidence of SSI can be found between a single-dose regimen and a multidose regimen. In our study, 13.8% of all patients received intraoperative redosing, although mean operation time was 2.8 h; 75.0% patients received postoperative prophylaxis, although prophylactic antibiotics are recommended to be given for \24 h after operation.…”

Antimicrobial prophylaxis in colorectal surgery: focus on ertapenem

“…However, three major considerations should be made on this subject prior to translation of this study’s conclusions in extensive clinical practice. First, several antibiotic regimens have been found not inferior to cefotetan in colorectal surgery prophylaxis,43 and, so far, we do not have data that directly compare ertapenem with these antimicrobial agents. In comparing the relative efficacy of different antimicrobial agents in colorectal surgery prophylaxis, considerable discrepancies have been shown to exist between the direct and the indirect comparisons 90.…”

“…In 1998, Song and Glenny43 published a systematic review of 147 randomized trials in colorectal surgery in which more than 70 different antibiotic regimens were tested. The main conclusions of the authors were that antimicrobial prophylaxis is effective for the prevention of SSIs in colorectal surgery and that there are no significant differences in the prophylactic efficacy among the different antimicrobials studied.…”

“…Several different antibiotics have been studied as parenteral prophylactic regimens in colorectal surgery with similar estimates of efficacy. It is therefore very difficult, if not impossible, to identify the best one 43. However, some parenteral antibiotic regimens, such as intravenous cefoxitin or cefotetan, are so broadly used as to be considered as gold standard, and to which other antibiotic choices should be compared 42,55–60…”

Microbiology of Surgical Site Infections after Gastrointestinal Surgery in the South Region of The Netherlands

“…In gastrointestinal surgery, short course antimicrobial prophylaxis is generally accepted as an effective mean to reduce the incidence of SSI [20]. The choice of the agent should be based on the microorganisms associated with the procedures performed.…”