Impact of Oral Antimicrobial Prophylaxis on Surgical Site Infection and Methicillin-Resistant Staphylococcus aureus Infection After Elective Colorectal Surgery. Results of a Prospective Randomized Trial

Abstract

The impact of oral antimicrobial prophylaxis on the surgical site infection and methicillin-resistant Staphylococcus aureus (MRSA) infection after elective colorectal surgery was evaluated by a prospective randomized single-blind study. The patients were randomly allocated to receive either mechanical bowel cleansing with polyethylene glycol alone (group 1) or mechanical cleansing plus oral antimicrobial prophylaxis with kanamycin and erythromycin for 2 days prior to surgery (group 2). In both groups, cefotiam was intravenously given twice a day for 3 days. A total of 143 patients (71 for group 1 and 72 for group 2) were eligible. The incidence of a surgical site infection was 23.9% in group 1 and 11.1% in group 2 (P = 0.04). The incidence of MRSA infection including at surgical and remote sites was 11.1% in group 1 and 5.6% in group 2 (P = 0.19). A multivariate logistic regression analysis showed that the risk of surgical site infection was influenced by the choice of the chemical bowel preparation (P = 0.03) and blood loss (P < 0.01), while an MRSA infection was predominantly influenced by blood loss (P < 0.01) followed by coexisting underlying diseases (P = 0.07). These results suggest that preoperative antimicrobial prophylaxis would be useful for reducing the incidence of a surgical site infection without increasing the risk of an MRSA infection following elective colorectal surgery.

Short-term intravenous antimicrobial prophylaxis in combination with preoperative oral antibiotics on surgical site infection and methicillin-resistant Staphylococcus aureus infection in elective colon cancer surgery: Results of a prospective randomized trial

“…We previously reported that blood loss and associated medical diseases were signifi cant risk factors affecting MRSA infection following colorectal surgery. 12 The present results are in partial agreement with those of our previous reports. Although it may be of interest to determine whether According to Japanese classifi cation of colorectal carcinoma patients who developed postoperative MRSA infection were previously carriers of MRSA, we did not preoperatively examine the carrier status of any patient in this study.…”

Meta‐analysis of oral antibiotics, in combination with preoperative intravenous antibiotics and mechanical bowel preparation the day before surgery, compared with intravenous antibiotics and mechanical bowel preparation alone to reduce surgical‐site infections in elective colorectal surgery

“…A further three studies were excluded as they were duplicate publications using cohorts already included in the meta‐analysis11, 12, 13. The remaining 22 studies were included in the review, of which 14 were RCTs14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, and eight were observational cohorts2 4, 28, 29, 30, 31, 32, 33 ( Table 1; Table   S1, supporting information). These studies included a total of 57 207 patients.…”

“…In the 14 RCTs14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, involving 3014 patients, rates of SSI in patients given preoperative oral antibiotic prophylaxis, in combination with i.v. antibiotic prophylaxis and MBP, were compared with those in patients who received only i.v.…”

“…Seven RCTs14 16, 17, 18 20, 21 24, involving 1141 patients, examined rates of SSI in patients given a preoperative oral combination of an oral aminoglycoside (kanamycin or neomycin) and erythromycin, along with i.v. antibiotic prophylaxis and MBP, in comparison with patients who received only i.v.…”

Perioperative antibiotic prophylaxis in laparoscopic right hemicolectomy for colon cancer: A 48-Hour regimen

“…), environmental factors (i.e., ventilation in operating room, sterilization of surgical instruments, etc. ), and bacterial factors are thought to be the main causes of SSI (24)(25)(26)(27)(28)(29)(30). Surgery of the colon is associated with a high incidence of SSI compared with surgery addressed to other parts of the digestive tract.…”