Intravenous cephalosporin versus non-cephalosporin-based prophylaxis to prevent surgical site infections in colorectal surgery patients: A systematic review and meta-analysis

Abstract

Background Surgical site infection (SSI) is common in colorectal surgery patients and associated with morbidity and mortality. Guidelines recommend preoperative intravenous antimicrobial prophylaxis with aerobic and anaerobic coverage to reduce SSI risk. Cephalosporin based prophylaxis (CBP) regimens are recommended as first-line prophylaxis, and non-cephalosporin based are recommended as alternative prophylaxis (AP). We evaluate the efficacy of CBP versus AP in preventing surgical site infections in colorectal surgery patients. Methods A systematic review and meta-analysis was conducted of studies published between 2005 and 2020 in MEDLINE and Web of Science. Studies were excluded if intravenous antimicrobial prophylaxis was not administered, or if oral and intravenous prophylaxis were routinely co-administered. Heterogeneity was reported using the Q-statistic and I 2 -statistic. Publication bias was evaluated using a funnel plot and Egger test for small study effects. Statistical significance was defined as a two-sided p < 0.05. Results 11 studies met inclusion criteria. AP was not associated with increased SSI risk at 30 days compared to CBP (OR 1.01, 95% CI 0.91, 1.13; OR < 1 favors AP). There was no effect size variability in subgroup analysis comparing higher-to lower-quality studies (I 2 = 99%, P = 0.17). Subgroup analysis by publication year approached a significant difference in effect size between studies published prior to 2014 and later than 2014 (I 2 = 99%, P = 0.06). Conclusions Meta-analysis of 11 studies of SSI risk in adult colorectal surgery patients suggest that SSI risk is similar for patients receiving CBP or AP, subgroup analysis of studies published since 2014 suggest increased SSI risk with AP compared to CBP.

Effect of Pharmacoprophylaxis on Postoperative Outcomes in Adult Elective Colorectal Surgery: A Multi-Center Retrospective Cohort Study within an Enhanced Recovery after Surgery Framework

“…The adoption of enhanced recovery after surgery (ERAS ® ) core items has been shown to decrease serious postoperative complications (POCs) and reduce postoperative hospital length of stay (LOS), readmission rates, and overall hospital costs [1][2][3][4][5][6][7][8][9]. Protocolized prophylaxis of common POCs with pharmacotherapy, such as surgical site infection (SSI) with appropriate antibiotics [10][11][12][13], venous thromboembolism (VTE) with anticoagulants [14][15][16][17], and postoperative nausea and vomiting (PONV) using multi-modal approaches [18][19][20][21][22][23], among others, coupled with preoperative risk assessments [24][25][26][27][28][29][30][31][32][33][34], has become more prevalent in surgical practice. Still, elucidation of pharmacotherapy regimens associated with lower POCs, LOS, and readmission remains somewhat nascent [5,13,16,35,36].…”

“…Protocolized prophylaxis of common POCs with pharmacotherapy, such as surgical site infection (SSI) with appropriate antibiotics [10][11][12][13], venous thromboembolism (VTE) with anticoagulants [14][15][16][17], and postoperative nausea and vomiting (PONV) using multi-modal approaches [18][19][20][21][22][23], among others, coupled with preoperative risk assessments [24][25][26][27][28][29][30][31][32][33][34], has become more prevalent in surgical practice. Still, elucidation of pharmacotherapy regimens associated with lower POCs, LOS, and readmission remains somewhat nascent [5,13,16,35,36]. Moreover, estimates of the impact of pharmacotherapy prophylaxis on the attainment of positive patient outcomes in hospitals with "homegrown" enhanced recovery audit and feedback systems are publicly non-existent unless reported on public-facing hospital webpages, which, according to some reports, may be misleading information [37,38].…”

Association between perioperative prophylaxis with cefuroxime plus metronidazole or amoxicillin/clavulanic acid and surgical site infections in paediatric uncomplicated appendectomy: a Swiss retrospective cohort study

“…Observational studies of adults undergoing colorectal surgery suggest the possibility of effectiveness of perioperative prophlyaxis for SSI prevention being related to the type of regimen being used [ 10 , 11 ], but a recent systematic review and meta-analysis concluded that there was no difference in SSI between patients receiving cephalosporin and non-cephalosporin based regimens [ 12 ]. A range of regimens is recommended in continental Europe, with the use of a Penicillin antibiotic and a Beta-lactamase inhibitor preferred in France compared with a first or second generation cephalosporin plus metronidazole or an aminoglycoside in combination with clindamycin or metronidazole in Italy and the Netherlands [ 13 – 15 ].…”