Efficacy of Preoperative Antimicrobial Preparation of the Bowel

Nichols, Ronald Lee; Condon, Robert E.; Gorbach, Sherwood L.; Nyhus, Lloyd M.

doi:10.1097/00000658-197208000-00019

Cited by 194 publications

(56 citation statements)

References 14 publications

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“…According to the literature (Bornside & Cohn, 1969;Gorbach et al 1970;Nichols et al 1972) mechanical cleansing procedures without the administration of antibiotics do not have a profound impact on the colonic microflora. After conventional mechanical cleansing procedures an immediate decrease of the aerobic flora of 1-2 logs is found but is of relatively short duration.…”

Section: Discussionmentioning

confidence: 99%

Recolonization and colonization resistance of the large bowel after three methods of preoperative preparation of the gastrointestinal tract for elective colorectal surgery

Bogaard¹,

Weidema

Boven³

et al. 1986

J. Hyg.

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SUMMARYThe impact of three current types of preoperative large bowel preparation on the microbial flora and the colonization resistance (CR) was investigated in 15 volunteers. In the first group a whole gut irrigation was performed without administration of antibiotics (group WGI). In the second group 0 5 g/l metronidazole and 1 g/l neomycin was added to the irrigation fluid (group WGI + AB). A whole gut irrigation with prior oral administration of 11 mannitol 10 % was performed in the third group. The antibiotic prophylaxis in this group consisted of two doses of 80 mg gentamicin i.v. and 500 mg metronidazole orally 24 h after lavage (group Mann + AB). One hour after the mechanical cleansing procedure was finished all volunteers were orally contaminated with one dose of an Escherichia coli test strain. The aerobic faecal reduction due to the cleansing procedure was 2-3 logs, while for the anaerobes it was 4-5 logs. The anaerobic flora in group WGI recovered within 24 h, while the aerobes showed a transient 'overgrowth' for the period of 2 days. The overgrowth of aerobes in group WGI + AB was observed for more than a week and the total numbers of aerobes started gradually to decline after the anaerobic flora had reached pretreatment levels at day three or four. Despite the normal numbers of anaerobes present 24 h after treatment, overgrowth of E. coli was seen in the group Mann + AB, probably due to residual mannitol left in the intestinal tract. The test strain of E. coli was excreted for a period of 1 week by the volunteers in the groups WGI and Mann + AB, but it was isolated for more than 10 weeks in the group WGI+AB. It is thought that all three methods of preoperative large bowel preparation decreased the CR of the gastrointestinal tract because of a disturbance of the interaction between aerobic and anaerobic microorganisms and alterations of the colonic wall. The anaerobic microflora, however, appeared to be primarily responsible for the maintenance of the CR. Antimicrobial prophylaxis should consist of a high dose, short term, systemic antibiotic regimen, not only because an adequate serum level of an appropriate drug at the time of operation substantially decreases the incidence of postoperative septic complications but also because a systemic regimen scarcely influences the A. E. J. M. VAN DEN BOGAARD AND OTHERSCR of the gastrointestinal tract. ,-Aspartylglycine appeared to be a specific but not very sensitive marker for decreased CR.

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Section: Discussionmentioning

confidence: 99%

Recolonization and colonization resistance of the large bowel after three methods of preoperative preparation of the gastrointestinal tract for elective colorectal surgery

Bogaard¹,

Weidema

Boven³

et al. 1986

J. Hyg.

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“…Two oral regimens are now primarily used: (1) an aminoglycoside agent with erythromycin base, and (2) an aminoglycoside agent with metronidazole. The regimen most often chosen in the United States is neomycin and erythromycin base, which was introduced in 1972 [4,10,18,19]. In Europe and Australia, however, physicians prefer kanamycin and metronidazole or neomycin and metronidazole when oral antibiotics are administered [20].…”

Section: Oral Antibioticsmentioning

confidence: 99%

“…Therefore, it is recommended that 1 g each of neomycin and erythromycin base be given at 1.00 p.m., 2,00 p.m. and 11.00 p.m. on the day before operation (6 g in total) (table 1) [18,19,21]. The procedure should then be scheduled for about 8.00 a.m. the next morning.…”

Section: Oral Antibioticsmentioning

confidence: 99%

Mechanical and Antibacterial Bowel Preparation in Colon and Rectal Surgery

Nichols

Choe

Weldon³

2005

Chemotherapy

Self Cite

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Colorectal surgery performed prior to 1970 was fraught with postoperative infectious complications which occurred in more than 30–50% of all operations. Diversion of the fecal stream appeared mandatory when operating on an urgent or emergent basis, thereby requiring the performance of multiple, staged operations instead of a single surgery encompassing resection and primary anastomosis as is performed commonly today. Multiple studies conducted in the early 1970s determined that anaerobic colonic microflora were causative agents in postoperative infections in colon and rectal surgery, and these studies initiated the development of effective oral preoperative antibiotic prophylaxis in combination with preoperative mechanical bowel preparation. This dual-tier regimen significantly reduced the incidence of postoperative infectious complications, thus allowing most uncomplicated colon and rectal surgeries to be performed in a single stage without the need for the diversion of the fecal stream and multiple operations. Therefore, a preoperative mechanical and antibacterial bowel regimen serves as the cornerstone of modern elective colorectal surgery, and these regimens now comprise three therapeutic directives. The first step is preoperative mechanical cleansing of the bowel, which is then followed by preoperative oral antibiotic prophylaxis. Finally, perioperative parenteral antibiotics directed against aerobic and anaerobic colonic microflora are utilized.

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“…Poth introducing the idea that sulfa-based antibiotics were necessary to reduce colon bacteria yet were limited by their lack of effect on anaerobic bacteria [23][24][25]. Even when Nichols and Condon began their seminal work in the field by developing tactics to decrease anaerobic bacteria, they re-confirmed that mechanical cleansing had no effect on bacterial concentrations in the colon lumen [26]. Yet despite this ample and growing body of knowledge, including more recent reports showing that bowel cleansing has an adverse effect on the intestinal mucosa, surgeons continued to be seduced into abandoning oral antibiotics in favor of systemic antibiotics alone.…”

Section: Doctor Donald Fry Presentationmentioning

confidence: 99%

Proceedings of the First International Summit on Intestinal Anastomotic Leak, Chicago, Illinois, October 4–5, 2012

Shogan

Schardey³

et al. 2014

Surgical Infections

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Objective: The first international summit on anastomotic leak was held in Chicago in October, 2012 to assess current knowledge in the field and develop novel lines of inquiry. The following report is a summary of the proceedings with commentaries and future prospects for clinical trials and laboratory investigations. Background: Anastomotic leakage remains a devastating problem for the patient, and a continuing challenge to the surgeon operating on high-risk areas of the gastrointestinal tract such as the esophagus and rectum. Despite the traditional wisdom that anastomotic leak is because of technique, evidence to support this is weak-to-non-existent.Outcome data continue to demonstrate that expert high-volume surgeons working in high-volume centers continue to experience anastomotic leaks and that surgeons cannot predict reliably which patients will leak. Methods: A one and one-half day summit was held and a small working group assembled to review current practices, opinions, scientific evidence, and potential paths forward to understand and decrease the incidence of anastomotic leak. Results: Results of a survey of the opinions of the group demonstrated that the majority of participants believe that anastomotic leak is a complicated biologic problem whose pathogenesis remains ill-defined. The group opined that anastomotic leak is underreported clinically, it is not because of technique except when there is gross inattention to it, and that results from animal models are mostly irrelevant to the human condition. Conclusions: A fresh and unbiased examination of the causes and strategies for prevention of anastomotic leak needs to be addressed by a continuous working group of surgeons, basic scientists, and clinical trialists to realize a real and significant reduction in its incidence and morbidity. Such a path forward is discussed.

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Efficacy of Preoperative Antimicrobial Preparation of the Bowel

Cited by 194 publications

References 14 publications

Recolonization and colonization resistance of the large bowel after three methods of preoperative preparation of the gastrointestinal tract for elective colorectal surgery

Recolonization and colonization resistance of the large bowel after three methods of preoperative preparation of the gastrointestinal tract for elective colorectal surgery

Mechanical and Antibacterial Bowel Preparation in Colon and Rectal Surgery

Proceedings of the First International Summit on Intestinal Anastomotic Leak, Chicago, Illinois, October 4–5, 2012

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