Surgical site infection in elective colonic and rectal resections: effect of oral antibiotics and mechanical bowel preparation compared with mechanical bowel preparation only

Ghuman, Amandeep; Kasteel, Naomi; Brown, C. J.; Karimuddin, Ahmer; Raval, Manoj J.; Wexner, Steven D.; Phang, P. Terry

doi:10.1111/codi.15153

Cited by 12 publications

(12 citation statements)

References 30 publications

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“…However, our study indicated that it was not very common to using oral antibiotics for the bowel preparation of colorectal surgery in China. There are many studies reporting that rectal operations had a higher risk than colectomies [33,34]. Although rectal operations had a lower risk compared with colonic operations in this study, the multivariate analysis revealed that type of surgery was not the independent risk factor (P = 0.182) in Table 4.…”

Section: Discussionmentioning

confidence: 49%

Incidence and risk factors of surgical site infection following colorectal surgery in China: a national cross-sectional study

et al. 2020

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Purposes Surgical site infection (SSI) after colorectal surgery is a frequent complication associated with the increase in morbidity, medical expenses, and mortality. To date, there is no nationwide large-scale database of SSI after colorectal surgery in China. The aim of this study was to determine the incidence of SSI after colorectal surgery in China and to further evaluate the related risk factors. Methods Two multicenter, prospective, cross-sectional studies covering 55 hospitals in China and enrolling adult patients undergoing colorectal surgery were conducted from May 1 to June 30 of 2018 and the same time of 2019. The demographic and perioperative characteristics were collected, and the main outcome was SSI within postoperative 30 days. Multivariable logistic regressions were conducted to predict risk factors of SSI after colorectal surgery. Results In total, 1046 patients were enrolled and SSI occurred in 74 patients (7.1%). In the multivariate analysis with adjustments, significant factors associated with SSI were the prior diagnosis of hypertension (OR, 1.903; 95% confidence interval [CI], 1.088–3.327, P = 0.025), national nosocomial infection surveillance risk index score of 2 or 3 (OR, 3.840; 95% CI, 1.926–7.658, P < 0.001), laparoscopic or robotic surgery (OR, 0.363; 95% CI, 0.200–0.659, P < 0.001), and adhesive incise drapes (OR, 0.400; 95% CI, 0.187–0.855, P = 0.018). In addition, SSI group had remarkably increased length of postoperative stays (median, 15.0 d versus 9.0d, P < 0.001), medical expenses (median, 74,620 yuan versus 57,827 yuan, P < 0.001), and the mortality (4.1% versus 0.3%, P = 0.006), compared with those of non-SSI group. Conclusion This study provides the newest data of SSI after colorectal surgery in China and finds some predictors of SSI. The data presented in our study can be a tool to develop optimal preventive measures and improve surgical quality in China.

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Section: Discussionmentioning

confidence: 49%

Incidence and risk factors of surgical site infection following colorectal surgery in China: a national cross-sectional study

et al. 2020

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“…In 1972, Nichols et al [ 23 ] introduced a protocol using neomycin and erythromycin with MBP, which reduced the SSI rate from 43% to 9% [ 24 , 25 ]. This protocol proved that the combination of preoperative OA and MBP could synergistically decrease the intestinal bacterial load prior to surgery, thus reducing the contamination of the operative field [ 12 , 26 ]. Multiple trials from the 1970s to the 1990s demonstrated the effectiveness of this approach.…”

Section: History Of Bowel Preparationmentioning

confidence: 99%

“…Multiple trials from the 1970s to the 1990s demonstrated the effectiveness of this approach. However, it was found that systemic antibiotics (SA) with MBP were more effective than OA with MBP [ 26 ].…”

Section: History Of Bowel Preparationmentioning

confidence: 99%

“…Similarly, the results of meta-analyses demonstrated no benefit from MBP [ 36 ]. Therefore, MBP with antibiotics was largely abandoned because of concerns about the efficacy and safety of MBP [ 26 ].…”

Section: History Of Bowel Preparationmentioning

confidence: 99%

“…Ghuman et al [ 26 ] reported a significant reduction in overall SSI rates (26.2% vs. 15.3%, P = 0.02) and superficial SSI rates (11.1% vs. 4.4%, P=0.02), but not in organ space SSI rates (15.1% vs. 10.9%, P=0.18).…”

Section: Current Issues Of Bowel Preparationmentioning

confidence: 99%

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A Review of Bowel Preparation Before Colorectal Surgery

Min

2021

Ann Coloproctol

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Some patients who have undergone preoperative chemoradiotherapy (CRT) following surgery have been diagnosed with late recurrence more than 5 years after treatment, raising questions about the possible benefit extending surveillance beyond the recommended 5 years. In 2011, a 71-year-old male was diagnosed with T3N+ low-lying rectal cancer located 3 cm from the anal verge before undergoing long-course preoperative CRT. After CRT, the patient was reexamined and diagnosed with ycT1-2N0 lesion, so local excision(LE) was performed. The patient underwent intensive surveillance for up to 5 years, and no evidence of recurrence was found. At 74 months after surgery, the patient was hospitalized for a hematochezia, and local recurrence at the excision site and peritoneal seeding nodules were identified. Considering the late recurrence in this patient, it might be necessary to long-term follow-up beyond 5 years in patients with preoperative CRT followed by LE.

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Modified oral antibiotics and mechanical bowel preparation (OAMBP) versus conventional OAMBP for sigmoid colon and rectal surgery: A multicenter randomized non‐inferiority trial

Arai,

Hanaoka,

Yamauchi

et al. 2024

Annals of Gastroent Surgery

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AimTo evaluate whether the use of a laxative with reduced patient burden in oral antibiotics and mechanical bowel preparation (OAMBP) could prevent surgical site infection (SSI) in left‐sided colon and rectal cancers.MethodsThis multicenter, non‐blinded, randomized, non‐inferiority trial included patients who underwent elective colorectal surgery for colorectal cancer in a university and community hospital in Japan from April 1, 2021 to March 31, 2023. We compared conventional OAMBP (polyethylene glycol, metronidazole, and kanamycin) (cOAMBP group) with modified OAMBP (sodium picosulfate hydrate, metronidazole, and kanamycin) (mOAMBP group). The primary outcome was overall incidence of SSI. Secondary outcomes were postoperative complications, degree of patient burden, and intraoperative bowel dilatation.ResultsAmong 119 patients, 112 were randomly assigned to the two groups, with 56 patients in each group. SSI occurred in three (5.4%) and five patients (8.3%) in the mOAMBP and cOAMBP groups, respectively (90% confidence interval [CI]: −12.8–5.3), with a 15% margin of non‐inferiority. Anastomotic leakage occurred in no patient in the mOAMBP group and three patients (5.4%) in the cOAMBP group (p = 0.24). The cOAMBP group reported significantly more pain than the mOAMBP group (50 [90.9%] vs. 7 [12.5%] participants). The mOAMBP group showed significantly lesser bowel dilatation than the cOAMBP group (1 [1.8%] vs. 21 [37.5%] participants).ConclusionmOAMBP is safe and less burdensome, can reduce intraoperative bowel dilatation, and is non‐inferior compared with cOAMBP in preventing SSI. Therefore, mOAMBP may be more suitable for sigmoid colon and rectal cancer.Trial RegistrationUMIN000043162 (http://www.umin.ac.jp/ctr/). Registered on January 28, 2021.

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Surgical site infection in elective colonic and rectal resections: effect of oral antibiotics and mechanical bowel preparation compared with mechanical bowel preparation only

Cited by 12 publications

References 30 publications

Incidence and risk factors of surgical site infection following colorectal surgery in China: a national cross-sectional study

Incidence and risk factors of surgical site infection following colorectal surgery in China: a national cross-sectional study

A Review of Bowel Preparation Before Colorectal Surgery

Modified oral antibiotics and mechanical bowel preparation (OAMBP) versus conventional OAMBP for sigmoid colon and rectal surgery: A multicenter randomized non‐inferiority trial

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