Perioperative Selective Decontamination of the Digestive Tract (SDD) in Elective Colorectal Surgery

Roos, Daphne; Dijksman, Lea M.; Sondermeijer, Brigitte M.; Straaten, Heleen M. Oudemans–van; Wit, L. T. de; Gerhards, Michael F.

doi:10.1007/s11605-009-0970-z

Cited by 26 publications

(21 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This high prophylactic efficacy might be due to specific pharmacokinet profile of these antimicrobials which ensures the bactericidal actions against aerobic and anaerobic pathogenic organisms. Similar results for prophylactic efficacy of ceftriaxone sodium in combination with metronidazole also discussed by Athar et al, (1996), Gravante andCaruso(2009), Lalla (2009), Rau et al, (2000) and Ross et al, (2009).…”

Section: Discussionsupporting

confidence: 82%

Comparative Prophylactic Administration Effect of Metronidazole, Ceftriaxone Sodium and their Combination on the Tensile Strength of End-to-End Jejunal Anastmotic Site in Dogs

Rafique¹,

Asi²,

Saqib³

et al. 2013

IJVMR

View full text Add to dashboard Cite

Intestinal resections are most commonly performed in dogs and currently it is involved with extensive use of different antibiotics before surgical intervention. Metronidazole and cephalosporins are considered as best choice for prophylactic use in gastrointestinal operations. Therefore, the study is established to reveal the comparative effect of metronidazole, ceftriaxoine sodium and their combination on the tensile strength of jejunual anastomotic site. A total of twenty healthy stray dogs were included in this study. These dogs were randomly divided into four groups, which underwent end to end jejunal ansastmosis. The dogs in Group I (control) were operated for jejunal anstomosis without any antibiotic prophylaxis. The metronidazole alone was administered intravenously to dogs in Group II at the dose rate of 50mg/kg while the dogs in Group III were administered with intravenous ceftriaxone sodium at the dose rate of 30mg/Kg body weight two hours prior to surgery. The dogs in Group IV were given metronidazole in combination with ceftriaxone sodium by intravenous route at the dose rate of 50mg/Kg and 30mg/kg respectively two hours before surgical intervention. A significant difference was noted in the tensile strength between the four studied groups (P < 0.05). The study concluded that the combination of ceftriaxone sodium with metronidazole was found to enhance the gain in tensile strength significantly i.e. 47.50 %.

show abstract

Section: Discussionsupporting

confidence: 82%

Comparative Prophylactic Administration Effect of Metronidazole, Ceftriaxone Sodium and their Combination on the Tensile Strength of End-to-End Jejunal Anastmotic Site in Dogs

Rafique¹,

Asi²,

Saqib³

et al. 2013

IJVMR

View full text Add to dashboard Cite

show abstract

“…Alternatively, it has been demonstrated that SDD with antibiotics prior to resection of colorectal carcinoma reduced post-surgical infectious complications and anastomotic leakage. 54 We observed that treatment of rats with a SDD regime prior to colectomy resulted in diminished adherence of tumor cells in the liver, compared to untreated animals. Taken together, it is likely that the bacterial load as well as blood endotoxin concentrations are reduced after SDD, which may lead to a decreased risk of developing liver metastases and improved oncological outcome for patients.…”

Section: Discussionmentioning

confidence: 82%

Spillage of bacterial products during colon surgery increases the risk of liver metastases development in a rat colon carcinoma model.

et al. 2018

View full text Add to dashboard Cite

Surgical resection of the primary tumor provides the best chance of cure for patients with colorectal carcinoma (CRC). However, bacterial translocation during intestinal surgery has been correlated with poor long-term oncological outcome. Therefore, we investigated the influence of bacterial contamination during colon surgery on CRC liver metastases development. Blood and liver samples of patients undergoing resection of primary CRC or liver metastases were collected. Cell numbers, activation markers and inflammatory mediators were determined. Tumor cell adhesion and outgrowth after sham- or colectomy operations were determined in a rat model, in which tumor cells had been injected into the portal vein.White blood cells and granulocytes were increased in per- and post-operative patient blood samples. IL-6 was also increased post-operatively compared to the preoperative level. Expression of NOX-2, NOX-4 and polymorphonuclear cells (PMNs) numbers were elevated in post-operative human liver samples. In vitro stimulation of macrophages with plasma of rats after colectomy resulted in production of reactive oxygen species (ROS). Colectomy in rats increased D-lactate levels in plasma, supporting bacterial translocation. Decreased expression of tight junction molecules and increased tumor cell adhesion and outgrowth was observed. Treatment with a selective decontamination of the digestive tract (SDD) cocktail decreased tumor cell adherence after colectomy.In conclusion, postoperative bacterial translocation may activate liver macrophages and PMNs, resulting in ROS production. As we previously showed that ROS release led to liver vasculature damage, circulating tumor cells may adhere to exposed extracellular matrix and grow out into liver metastases. This knowledge is pivotal for development of therapeutic strategies to prevent surgery-induced liver metastases development.

show abstract

“…The results are promising and suggest that postoperative infectious complications can be reduced by applying SDD before and after surgery [5]. In a prospective randomized controlled trial by our group, perioperative SDD did indeed decrease infectious complications, and also the rate of anastomotic leakage (accepted for publication).…”

Section: Introductionmentioning

confidence: 85%

“…Only one study on the use of perioperative SDD with a combination of polymyxin B sulfate, tobramycin and amphotericin B in elective colorectal surgery has been published in full. This retrospective study showed that the use of perioperative SDD in elective colorectal surgery in addition to standard parenteral prophylaxis significantly decreased infectious complications [5]. …”

Section: Discussionmentioning

confidence: 99%

Current Application of Selective Decontamination of the Digestive Tract, Perioperative Antibiotics and Mechanical Bowel Preparation in Surgical Departments in the Netherlands

et al. 2011

View full text Add to dashboard Cite

Objective:To study the current application of selective decontamination of the digestive tract (SDD), the use of preoperative antibiotics and mechanical bowel preparation (MBP) in elective gastrointestinal (GI) surgery in surgical departments in the Netherlands. Methods:A point prevalence survey was carried out and an online questionnaire was sent to GI surgeons of 86 different hospitals. Results:The response rate was 74%. Only 4/64 (6.3%) of the Dutch surgical wards are currently using perioperative SDD as a prophylactic strategy to prevent postoperative infectious complications. The 4 hospitals using SDD on their surgical wards also use it on their ICUs. All hospitals make use of perioperative intravenous antibiotic prophylaxis in elective GI surgery. In most hospitals, a cephalosporin and metronidazole are applied (81.3 and 76.6%). MBP was used in 58 hospitals (90.6%) mainly in left colonic surgery. Conclusions: Perioperative SDD is rarely used in elective GI surgery in the Netherlands. Perioperative intravenous antibiotic prophylaxis is given in all Dutch hospitals, conforming to guidelines. Although the recent literature does not recommend MBP before surgery, it is still selectively used in 90.6% of the Dutch surgical departments, mainly in open or laparoscopic left colonic surgery (including sigmoid resections).

show abstract

Perioperative Selective Decontamination of the Digestive Tract (SDD) in Elective Colorectal Surgery

Abstract: Perioperative SDD in elective colorectal surgery seems to reduce postoperative surgical complications including infectious complications and anastomotic leakage. Prospective, randomized, placebo-controlled studies are needed to confirm this conclusion.

Cited by 26 publications

References 24 publications

Comparative Prophylactic Administration Effect of Metronidazole, Ceftriaxone Sodium and their Combination on the Tensile Strength of End-to-End Jejunal Anastmotic Site in Dogs

Comparative Prophylactic Administration Effect of Metronidazole, Ceftriaxone Sodium and their Combination on the Tensile Strength of End-to-End Jejunal Anastmotic Site in Dogs

Spillage of bacterial products during colon surgery increases the risk of liver metastases development in a rat colon carcinoma model.

Current Application of Selective Decontamination of the Digestive Tract, Perioperative Antibiotics and Mechanical Bowel Preparation in Surgical Departments in the Netherlands

Contact Info

Product

Resources

About