Historical development of intestinal antisepsis

Abstract

The study of intestinal antisepsis has been the concern of the author for the past 40 years. Pioneer studies of sulfanilamide, sulfanilylguanidine, succinylsulfanilamide, succinylsulfathiazole, and phthalylsulfathiazole in dogs are reported, and subsequent clinical trials are detailed. By 1948, intestinal antisepsis had become an established procedure to complement adequate mechanical cleansing. Careful attention to meticulous, gentle handling of tissues, preservation of maximum blood supply, and strict aseptic technique should be continued; intestinal antisepsis is not a substitute for surgical principles. A combination of neomycin‐phthalylsulfathiazole, together with the above‐named practices, has resulted in an abdominal wall wound infection rate below 3%, with no intra‐abdominal complications due to postoperative infection.

Benefit of mechanical bowel preparation prior to elective colorectal surgery: current insights

“…Although bowel cleansing was found to potentially reduce the total fecal and bacterial load, the concentration of microorganisms was found to remain unchanged [8]. Cathartics used alone were shown very early on to have no effect on SSI, including anastomotic leak rate [10].…”

“…Their effective access to the colon logically requires the reduction of fecal load [8]. Very few data exist evaluating the effects of oral antibiotics alone; however recently, a retrospective study shows reduced SSI with oral antibiotics alone and an additional effect with prior cleansing [16].…”

“…In the mid-part of the 20th century surgical mortality was 10-12 % and suppurating wound infections occurred in 80-90 % of survivors in the best-reported series. Staged operations were frequent and colon anastomoses were usually of the Bclosed^type with proximal colostomies [8].…”

“…In order to have maximal effect on the complex bacterial community present in the colon, an oral antibiotic needs to be broad spectrum, chemically stable in the intestinal environment, with low absorption from the GI tract and be palatable for patients [8].…”

Gut overgrowth harms the critically ill patient requiring treatment on the intensive care unit

“…It is a contradiction in terms to be selective and yet achieve effective decontamination or eradication of aerobic overgrowth. To achieve selective eradication of aerobic overgrowth would lower the rate of molecular oxygen consumption permitting an increase in pO 2 of the gut lumen content from 5mmHg to 60mmHg; (20) under such conditions strictly anaerobic micro-organisms can no longer survive even though they may not themselves be sensitive to the decontaminating agents. …”