Prospective Randomized Study on the Effectiveness of Oral Antibiotic Prophylaxis in Preventing Surgical Site Infection in Elective Colorectal Surgery

Title: Prospective Randomized Study on the Effectiveness of Oral Antibiotic Prophylaxis in Preventing Surgical Site Infection in Elective Colorectal Surgery

Authors: Govindappa Saroja Murali*, Preetham Rai

DOI: http://dx.doi.org/10.18535/jmscr/v4i8.26

Abstract

References

Corresponding Author

Abstract

Background: Surgeries of the colon and rectum are categorized as clean-contaminated procedures. Increased incidence of surgical site infections associated with these procedures make antibiotic prophylaxis and bowel preparation an essential component in the preoperative preparation of the patients. While the role of intravenous antibiotics is well established, controversy still exists over the use of oral antibiotics for prophylaxis. This study was undertaken to evaluate the role of oral antibiotic prophylaxis in preventing/ reducing the incidence of wound infection following elective colorectal surgeries.

Methods: 82 patients who underwent elective surgeries on the colon/rectum over 32 months were included in the study. They were randomized into two groups – Group 1 (with oral prophylaxis) and Group 2 (without oral prophylaxis). Postoperatively intravenous antibiotics were given for 2 days following which no antibiotics were given. Wound was inspected for evidence of infection.

Results: Overall incisional SSI rate was 31%. Infection rate was higher in females (33.3%) than in males (30%). Patients with higher ASA grade had high infection rates (p<0.0001) (Grade I – 14.3%; Grade II – 26%; Grade III – 50%). Patients in age group > 60 yrs had increased infection rates (p<0.0001) (20 – 40 yrs – 14.3%; 40 – 60 yrs – 26.1%; > 60 yrs – 50%). 5 patients from Group 1(n=40) and 8 from Group 2 (n=42) developed incisional SSI without any statistically significant difference (p=0.514). One patient developed urinary tract infection.

Conclusion: This study did not find any significant role for oral antibiotics in decreasing the infection rates. Hence oral antibiotics need not be administered preoperatively for colorectal surgeries.

Keywords: Antibiotic prophylaxis, Surgical site infection, Colorectal surgery.

References

1. Ronald T. Lewis. Oral versus systemic antibiotic prophylaxis in elective colon surgery: a randomized study and meta-analysis send a message from the 1990s. Can J Surg.2002 June;45(3):173-80.

2. Shin Fujita, Norio Saito, Tetsuji Yamada, Yasumasa Takii, Ken Kondo, Masayuki Ohue et al. Randomized, Multicenter Trial of Antibiotic Prophylaxis in Elective Colorectal Surgery. Single Dose vs 3 Doses of a Second-Generation Cephalos-porin without Metronidazole and Oral Antibiotics. Arch Surg.2007;142 (7):657-61

3. Kobayashi M, Mohri Y, Tonouchi H, Miki C, Nakai K, Kusunoki M. Randomized clinical trial comparing intravenous antimicrobial prophylaxis alone with oral and intravenous antimicrobial prophylaxis for the prevention of a surgical site infection in colorectal cancer surgery. Surg Today 2007;37:383–8

4. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 1992; 20:271–274.

5. Espin Basany Eloy, Sanchez Garcia Jose Luis, Lopez Cano Manuel, Lozoya Trujillo Roberto,Medarde Ferrer Meritxell,Armadans Gil Lluis et al. Prospective randomized study on oral antibiotics in colorectal surgery-Is it really necessary to use oral antibiotics? International journal of colorectal disease .2005;20(6):542-6.

6. Konishi T, Watanabe T, Kishimoto J, Nagawa H. Elective colon and rectal surgery differ in risk factors for wound infection. Ann Surg. 2006;244(5):758–763

7. Yunus A. Gul, Lee H. Lian, Faisal M. Jabar, Kevin Moissinac. Antibiotic prophylaxis in elective colorectal surgery. ANZ Journal of Surgery 2002;72(4):275-8.

8. J.W. Lumley, S.K. Siu, S.P. Rllay, R. Stitz, R.J. Kemp, J. Faoagali et al. Single dose ceftriaxone as prophylaxis for sepsis in colorectal surgery. ANZ Journal of surgery. 1992; 62(4):292-6.

9. Reiping T, Hwa CH, Liang WY, Rong CC, Shiun CJ, Cheng HK, et al. Risk factors for surgical site infection after elective resection of the colon and rectum: A Single-Center Prospective Study of 2,809 Consecutive Patients. Ann Surg 2001;234(2):181-189

10. Jimenez JC, Wilson SE. Prophylaxis of infection for elective colorectal surgery. Surgical Infections.2003 Sept;4(3):273-80.

11. Suzuki T, Sadahiro S, Maeda Y, Seiei Y, Makuuchi H. The optimum duration of perioperative prophylactic antibiotic administration in patients with colon cancer: a randomized comparative study. J Jpn Soc Surg Infect 2006;3:267–71.

12. Wren SM, Ahmed N, Jamal A, Safadi BY. Preoperative oral antibiotics in colorectal surgery increase the rate of Clostridium difficile colitis. ArchSurg 2005;140:752–6.

13. Gorbach SL. Antimicrobial prophylaxis for appendectomy and colorectal surgery. Reviews of infectious diseases 1991;13 (Suppl. 10):815–20.

14. Culver DH, Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG et al: Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med 1991; 91(Suppl 3B):152S-1527S.

15. Kirkland KB, Briggs JP, Trivette SL, Wilkinson SE, Sexton DJ. The impact of surgical site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infection Control Hosp Epidemiol 1994; 20:725-30.

16. Tang R, Chen HH, Wang YL, Changchien CR, Chen JS, Hsu KC et al. Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2,809 consecutive patients. Ann Surg. 2001;234:181–189.

17. H.G. Rau, U. Mittelkötter, A. Zimmermann, A. Lachmann, L. Köhler, K.H. Kullmann. Perioperative Infection Prophylaxis and Risk Factor Impact in Colon Surgery. International Journal of Experimental and Clinical Chemotherapy. 2000;46(5):353-63.

18. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999;20:250–78.Smith RL, Bohl JK, McElearney ST, Friel CM, Barclay MM, Sawyer RG et al.Wound infection after elective colorectal surgery. Ann Surg 2004;239:599–607.

19. Zmora O, Wexner SD, Hajjar L, Park T, Efron JE, Nogueras JJ et al. Trends in preparation for colorectal surgery: survey of the members of the American Society of Colon and Rectal Surgeons. Am Surg. 2003;69(2):150-154.

20. Belda FJ, Aguilera L, Garcia de la Asuncion J, Alberti J, Vicente R, Ferrándiz L et al: Supplemental perioperative oxygen and the risk of surgical wound infection: A randomized controlled trial. JAMA 2005; 294:2035-2042.

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