Antibiotic Bowel Decontamination in Gastrointestinal Surgery—A Single-Center 20 Years’ Experience

Abstract

ObjectiveAnastomotic leakage, surgical site infections, and other infectious complications are still common complications in gastrointestinal surgery. The concept of perioperative antibiotic bowel decontamination demonstrates beneficial effects in single randomized controlled trials (RCTs), but data from routine clinical use are still sparse. Our aim was to analyze the data from the routine clinical use of perioperative antibiotic bowel decontamination in gastrointestinal surgery.MethodsBased on 20 years’ experience, we performed a retrospective analysis of all cases in oncologic gastrointestinal surgery with the use of antibiotic bowel decontamination in gastric, sigmoid, and rectal cancer. Clinical data and perioperative outcomes were analyzed, especially regarding anastomotic leakage, surgical site infections, and other infectious complications.ResultsA total of n = 477 cases of gastrointestinal surgery in gastric cancer (n = 80), sigmoid cancer (n = 168), and rectal cancer (n = 229) using a perioperative regimen of antibiotic bowel decontamination could be included in this analysis. Overall, anastomotic leakage occurred in 4.4% (2.5% gastric cancer, 3.0% sigmoid cancer, 6.1% rectal cancer) and surgical site infections in 9.6% (6.3% gastric cancer, 9.5% sigmoid cancer, 10.9% rectal cancer). The incidence of all infectious complications was 13.6% (12.5% gastric cancer, 11.3% sigmoid cancer, 15.7% rectal cancer). Mortality was low, with an overall rate of 1.1% (1.3% gastric cancer, 1.8% sigmoid cancer, 0.4% rectal cancer). Antibiotic decontamination was completed in 98.5%. No adverse effects of antibiotic bowel decontamination could be observed.ConclusionOverall, in this large cohort, we can report low rates of surgery-related serious morbidity and mortality when perioperative antibiotic bowel decontamination is performed. The rates are lower than other clinical reports. In our clinical experience, the use of perioperative antibiotic bowel decontamination appears to improve patient safety and surgical outcomes during gastrointestinal oncologic procedures in a routine clinical setting.

Microbial Normal Flora: Its Existence And Their Contribution To Homeostasis

“…Treatment with the antibiotics, broad spectrum or not, did diminished intestinal microflora, quantitatively and qualitatively, but actually had no effect on the incidence of expected complication, e.g., such as post-surgical infections, sepsis, prolonged wound, pneumonia or fatal organ failure [94][95][96]. Unfortunately, long term follow up on the practice of gut decontamination among surgical patients did result in higher rates of oxacillin-resistant Staphylococcus aureus, which actually used to be part of normal flora but then changed in its characteristics due to long term antibiotics administration.…”

“…Another example is the common practice of antibiotics administered orally or intravenously to sterilize and decontaminate the gut in order of patient preparation for intestinal surgery [94]. Common post-surgical complication is infections that was usually of intestinal origin.…”

“…Most studies of antibiotics and their impact on normal microflora have been aimed at (1) Its direct killing ability and (2) The development of antibiotic resistance [93][94][95][96]. However, there are a few studies on the impact antibiotics have on normal microflora.…”