Clinical outcomes following mechanical plus oral antibiotic bowel preparation versus oral antibiotics alone in patients undergoing colorectal surgery

Abstract

BackgroundDespite growing evidence to support use of preoperative mechanical bowel preparation (MBP) plus oral antibiotic bowel preparation (OABP) compared with MBP alone or no bowel preparation before colorectal surgery, evidence supporting use of MBP plus OABP relative to OABP alone is lacking. This study aimed to investigate whether the addition of MBP to OABP was associated with improved clinical outcomes after colorectal surgery compared with outcomes following OABP alone.MethodsPatients who underwent colorectal surgery and preoperative bowel preparation with either OABP alone or MBP plus OABP were identified using the American College of Surgeons' National Surgical Quality Improvement Program Colectomy Targeted Participant Use Data File for 2012–2015. Thirty‐day postoperative outcomes were compared, estimating the average treatment effect with propensity score matching and inverse probability‐weighted regression adjustment.ResultsIn the final study population of 20 594 patients, 90·2 per cent received MBP plus OABP and 9·8 per cent received OABP alone. Patients who received MBP plus OABP had a lower incidence of superficial surgical‐site infection (SSI), organ space SSI, any SSI, postoperative ileus, sepsis, unplanned reoperation and mortality, and a shorter length of hospital stay (all P < 0·050). After propensity score matching and inverse probability‐weighted regression adjusted analysis, MBP plus OABP was associated with a reduction in superficial SSI, any SSI, postoperative ileus and unplanned reoperation (all P < 0·050).ConclusionsUse of MBP plus OABP before colectomy was associated with reduced SSI, postoperative ileus, sepsis and unplanned reoperations, and shorter length of hospital stay compared with OABP alone.

AIM2 inflammasome-derived IL-1β induces postoperative ileus in mice

“…We also recently demonstrated that intestinal antimicrobial peptides are regulated in an IL-1R1 dependent manner in POI 29 . An impact of oral antibiotics on the length of POI was shown in two recent metanalysis in patients undergoing colorectal surgery 50,51 and omission of oral antibiotics was found to be an independent risk factor for development of POI 3 . Nevertheless, the role of the microbiome in POI is not totally clear, as the antibiotic regime used in our study did not improve GI transit and antibiotic-treated animals demonstrated disturbed motility even in absence of the surgical procedure which was also shown by others 52 .…”

Prevention of severe infectious complications after colorectal surgery using oral non-absorbable antimicrobial prophylaxis: results of a multicenter randomized placebo-controlled clinical trial

“…Data on the effectiveness of OAP without simultaneous MBP is also provided by several retrospective observational studies that compared the different bowel preparation strategies. These studies reported conflicting results on effectiveness [25][26][27][28][29][30][31][32][33][34][35][36]. Potential confounding by indication and limited numbers of patients treated with only OAP hamper concluding on the effectiveness of OAP in the absence of MBP and exemplifies the need for well-controlled and adequately powered studies.…”

Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection: an international, multi‐centre, prospective audit

“…This study adds to a growing body of evidence to support the addition of oral antibiotics to mechanical bowel preparation regimes for left sided colorectal surgery. A comprehensive systematic review published in 2018 described six randomised controlled trials testing MBP+ABx, failing to find a benefit upon meta‐analysis . However, half of included studies (three of six) were of unclear methodological quality and published more than 20 years ago.…”