Preoperative oral antibiotics reduce infections after colorectal cancer surgery

Abstract

AimThe objectives were to recognize the risk factors for surgical site infections (SSIs) after surgery due to colorectal cancer and to assess the impact of mechanical bowel preparation (MBP) and oral antibiotic prophylaxis (ABX) on SSIs.MethodsRecords from two colorectal centers were used. Risk factors of SSIs were categorized into patient-, disease-, and treatment-dependent.ResultsA group of 2240 patients was included. SSIs were noted in 364 patients (16.3 %). MBP+/ABX+ was connected with a lower incidence of anastomotic leak (AL) and organ-space SSIs: 2.4 vs. 6.3 %; p = 0.008 and 3.6 vs. 7.2 %; p = 0.017, respectively. Patient-dependent factors: obesity increased the risk of skin superficial SSIs, adjusted OR 1.53 (1.47–1.59 95 % confidence interval (95 % CI)), and deep incisional SSIs 1.42 (1.39–1.45 95 % CI). Disease-dependent factors: rectal cancer was associated with a higher risk of skin superficial and deep incisional SSIs, adjusted OR 1.28 (1.22–1.34 95 % CI) and 1.13 (1.09–1.15 95 % CI). Treatment-dependent factors: MBP+/ABX+ was associated with a lower risk of organ-space SSIs, adjusted OR 0.53 (0.44–0.59 95 % CI). Radiotherapy increased the risk of organ-space SSIs, adjusted OR 1.78 (1.75–1.80 95 % CI). The risk of organ-space SSIs was the highest after low anterior resection, adjusted OR 1.62 (1.60–1.64 95 % CI).ConclusionsIf possible, MBP and ABX should always be administered to decrease the risk of AL and organ-space SSIs. Factors strictly related to the treatment mostly increased the risk of organ-space SSIs.

The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery

“…From the 520 studies identified in the initial search, 40 studies 31 , 41 , 43 , 45 , 46 , 49 – 83 on 69,517 participants were included ( Supplementary Figure 1 , http://links.lww.com/SLA/B542 ). Of these 28 were RCTs with 6437 participants 49 – 53 , 55 – 59 , 61 – 67 , 69 – 73 , 75 , 76 , 78 – 80 , 83 and 12 were cohort (case control) studies with 63,080 participants.…”

“…Of these 28 were RCTs with 6437 participants 49 – 53 , 55 – 59 , 61 – 67 , 69 – 73 , 75 , 76 , 78 – 80 , 83 and 12 were cohort (case control) studies with 63,080 participants. 31 , 41 , 43 , 45 , 46 , 54 , 60 , 68 , 74 , 77 , 81 , 82 The risk of bias in the RCTs included was variable, with poor levels of documentation particularly surrounding randomization methods, allocation concealment, and blinding in the earlier studies ( Table 1 ). Six studies 57 , 58 , 62 , 64 – 66 administered different parenteral antibiotic regimens depending upon whether the patient was receiving MBP+OAB or MBP alone, which may provide significant source of bias in terms of SSI prevention.…”

“…Two studies 53 , 55 focused on surgery using laparoscopic techniques, 21 on open surgery alone, 46 , 50 , 52 , 57 , 58 , 61 , 62 , 64 – 74 , 76 , 78 , 80 with 9 studies 41 , 43 , 49 , 54 , 60 , 75 , 77 , 81 , 82 mixing both open and laparoscopic techniques and the remaining 8 studies not providing this information. 31 , 45 , 51 , 56 , 59 , 63 , 79 , 83 The most recent publication 31 included patients undergoing robotic surgery.…”

“…Finally, the national Veterans Affairs Surgical Quality Improvement Program was the basis for 2 studies 44 , 45 on the same regimen comparison, thus only the largest study was included within the meta-analysis. 45 One study 46 included a small proportion of patients undergoing emergency colorectal resection within the cohort (311 of a total population of 2240), so any outcomes that included this study were analyzed both with and without it included to discern any difference in results.…”

Low-fat/high-fibre diet prehabilitation improves anastomotic healing via the microbiome: an experimental model

“…Because the gut is constantly exposed to a high burden of microbial organisms, healing may be dependent on a delicate balance between the health‐promoting microbiota and the virulence of pathobiota. Studies in animals as early as 1955 demonstrated a key role for the colonic microbiota in the pathogenesis of anastomotic healing. A more recent study examining anastomotic tissues in rodents showed a significant loss of health‐promoting taxa such as Ruminococcus , Bacteroidales family S24‐7 and Prevotellaceae , with a significant bloom in Escherichia and Enterococcus .…”