The Efficacy of Kanamycin Plus Metronidazole Administration as an OABP Against Incisional Surgical Site Infection in Colorectal Cancer Surgery

Abstract

The purpose of this study was to assess the efficacy of kanamycin (KM) plus metronidazole (MNZ) administration as an oral antibiotic bowel preparation (OABP) for incisional surgical site infection (SSI) in colorectal cancer surgery. Methods: Three hundred forty-four patients who underwent elective colorectal surgery at our department from April 2010 to March 2015 were enrolled in this retrospective study. The patients were divided into three groups based on their OABP method: without OABP (n = 178), KM only (n = 87), and KM + MNZ (n = 79). We evaluated the incidence of adverse events and analyzed an association between the incidence of incisional SSI and variable factors using univariate and multivariate analyses. Results: Incisional SSI rates in each group were 14.0 (without OABP), 13.8 (KM only), and 1.3 (KM + MNZ). The KM + MNZ group had a significant lower SSI incidence than the other groups (P 0.05). There was no significant difference in the incidence of adverse events among the groups. Risk factors for SSI were male (P = 0.035) and without KM + MNZ (P = 0.011). Conclusions: Administration of KM + MNZ as OABP was effective in preventing incisional SSI in colorectal cancer surgery.

The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery

“…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.…”

“… 31 , 45 , 51 , 56 , 59 , 63 , 79 , 83 The most recent publication 31 included patients undergoing robotic surgery. The indication for surgery was colorectal cancer in 8 studies, 46 , 54 , 55 , 59 , 61 , 75 , 78 , 81 inflammatory bowel disease in 2, 67 , 80 with the remaining including a mixture of benign and malignant pathologies. Patient demographics and surgical variables as well as the details of MBP, OAB, and parenteral antibiotics administered are detailed in Table 2 .…”

“…The comparison between MBP+OAB versus MBP alone was performed in 35 studies; 26 RCTs 49 – 53 , 55 – 59 , 61 – 67 , 69 , 70 , 72 , 73 , 75 , 76 , 78 – 80 and 9 cohort studies 31 , 43 , 45 , 54 , 60 , 68 , 74 , 77 , 81 with a total of 47,610 patients. When all studies were considered ( Fig.…”

“…Five studies 31 , 43 , 51 , 53 , 54 were included in the comparison of MBP+OAB versus MBP; 2 RCTs 51 , 53 (879 patients) and 3 cohort studies (33,119 patients). 31 , 43 , 54 Only 1 study 43 provided a definition of ileus, with the other 4 studies 31 , 43 , 53 , 54 not providing a definition. Overall, the combination of MBP+OAB was associated a significant reduction in the incidence of postoperative ileus (RR 0.72, 95% CI 0.52–0.98, P = 0.04, I 2 = 36%).…”