Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection: an international, multi‐centre, prospective audit

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doi:10.1111/codi.14362

Cited by 48 publications

(7 citation statements)

References 30 publications

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“…Reduced rates of SSI and, to some extent, AL in patients receiving OABs plus MBP were shown in earlier studies [17,22,27,31,38,[42][43][44][45][46][47][48][49][50]; however, indications for surgery varied considerably in these studies and did not only include CRC, but also inflammatory bowel disease (IBD), fistulas, and other benign and/or infectious diseases that have a different post-operative complication risk. Furthermore, patients treated for IBD often used immunosuppressive medication, which influenced the incidence on infectious complications and tissue healing.…”

Section: Discussionmentioning

confidence: 92%

Oral Antibiotic Prophylaxis Reduces Surgical Site Infection and Anastomotic Leakage in Patients Undergoing Colorectal Cancer Surgery

et al. 2021

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Background: Surgical-site infection (SSI) and anastomotic leakage (AL) are major complications following surgical resection of colorectal carcinoma (CRC). The beneficial effect of prophylactic oral antibiotics (OABs) on AL in particular is inconsistent. We investigated the impact of OABs on AL rates and on SSI. Methods: A systematic review and meta-analysis of recent RCTs and cohort studies was performed including patients undergoing elective CRC surgery, receiving OABs with or without mechanical bowel preparation (MBP). Primary outcomes were rates of SSI and AL. Secondarily, rates of SSI and AL were compared in broad-spectrum OABs and selective OABs (selective decontamination of the digestive tract (SDD)) subgroups. Results: Eight studies (seven RCTs and one cohort study) with a total of 2497 patients were included. Oral antibiotics combined with MBP was associated with a significant reduction in SSI (RR = 0.46, 95% confidence interval (CI) 0.31–0.69), I2 = 1.03%) and AL rates (RR = 0.58, 95% CI 0.37–0.91, I2 = 0.00%), compared to MBP alone. A subgroup analysis demonstrated that SDD resulted in a significant reduction in AL rates compared to broad-spectrum OABs (RR = 0.52, 95% CI 0.30 to 0.91), I2 = 0.00%). Conclusion: OABs in addition to MBP reduces SSI and AL rates in patients undergoing elective CRC surgery and, more specifically, SDD appears to be more effective compared to broad-spectrum OABs in reducing AL.

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Section: Discussionmentioning

confidence: 92%

Oral Antibiotic Prophylaxis Reduces Surgical Site Infection and Anastomotic Leakage in Patients Undergoing Colorectal Cancer Surgery

et al. 2021

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“…Controversy exists over the optimal bowel preparation strategy in elective colorectal surgery, with previous European studies demonstrating low utilization of OAB (10–16.8 per cent) 36 , 100 . This NMA comparing different bowel preparation strategies consists solely of RCT data, including 60 RCTs and 16 289 patients.…”

Section: Discussionmentioning

confidence: 99%

“…The ACS and Surgical Infection Society (2017) 34 , the American Society of Colon and Rectal Surgeons (2019) 35 , and the WHO 10 guidelines recommend the use of OAB + MBP in elective colorectal surgery. However, there remains a large evidence–practice gap, with a recent international European multicentre audit in 2017 demonstrating low rates of utilization of this bowel preparation strategy, with only 16.8 per cent of patients receiving OAB + MBP versus 52.9 per cent receiving MBP 36 .…”

Section: Introductionmentioning

confidence: 99%

Mechanical bowel preparation and antibiotics in elective colorectal surgery: network meta-analysis

et al. 2023

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Background The use of intravenous antibiotics at anaesthetic induction in colorectal surgery is the standard of care. However, the role of mechanical bowel preparation, enemas, and oral antibiotics in surgical site infection, anastomotic leak, and other perioperative outcomes remains controversial. The aim of this study was to determine the optimal preoperative bowel preparation strategy in elective colorectal surgery. Methods A systematic review and network meta-analysis of RCTs was performed with searches from PubMed/MEDLINE, Scopus, Embase, and the Cochrane Central Register of Controlled Trials from inception to December 2022. Primary outcomes included surgical site infection and anastomotic leak. Secondary outcomes included 30-day mortality rate, ileus, length of stay, return to theatre, other infections, and side effects of antibiotic therapy or bowel preparation. Results Sixty RCTs involving 16 314 patients were included in the final analysis: 3465 (21.2 per cent) had intravenous antibiotics alone, 5268 (32.3 per cent) had intravenous antibiotics + mechanical bowel preparation, 1710 (10.5 per cent) had intravenous antibiotics + oral antibiotics, 4183 (25.6 per cent) had intravenous antibiotics + oral antibiotics + mechanical bowel preparation, 262 (1.6 per cent) had intravenous antibiotics + enemas, and 1426 (8.7 per cent) had oral antibiotics + mechanical bowel preparation. With intravenous antibiotics as a baseline comparator, network meta-analysis demonstrated a significant reduction in total surgical site infection risk with intravenous antibiotics + oral antibiotics (OR 0.47 (95 per cent c.i. 0.32 to 0.68)) and intravenous antibiotics + oral antibiotics + mechanical bowel preparation (OR 0.55 (95 per cent c.i. 0.40 to 0.76)), whereas oral antibiotics + mechanical bowel preparation resulted in a higher surgical site infection rate compared with intravenous antibiotics alone (OR 1.84 (95 per cent c.i. 1.20 to 2.81)). Anastomotic leak rates were lower with intravenous antibiotics + oral antibiotics (OR 0.63 (95 per cent c.i. 0.44 to 0.90)) and intravenous antibiotics + oral antibiotics + mechanical bowel preparation (OR 0.62 (95 per cent c.i. 0.41 to 0.94)) compared with intravenous antibiotics alone. There was no significant difference in outcomes with mechanical bowel preparation in the absence of intravenous antibiotics and oral antibiotics in the main analysis. Conclusion A bowel preparation strategy with intravenous antibiotics + oral antibiotics, with or without mechanical bowel preparation, should represent the standard of care for patients undergoing elective colorectal surgery.

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“…This trend has continued in the United States and Canada since the 80s (5-7, [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] with good results regarding SSI decrease. But this is not the case in Europe (32)(33)(34)(35)(36), where the ERAS ® program (37) and the guidelines of the British National Institution of Health and Clinical Excellence 2008 (38) reject MBP and advocate the superiority of intravenous prophylaxis for SSI prevention, reporting an increased incidence of pseudomembranous colitis and antibiotic resistance associated with oral prophylaxis (39).…”

Section: Discussionmentioning

confidence: 99%

Bundles reduce anastomosis leak in patients undergoing elective colorectal surgery. A propensity score-matched study

Baeza-Murcia

Valero-Navarro²,

Pellicer-Franco³

et al. 2023

Front. Surg.

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Backgroundanastomosis leak still being a handicap in colorectal surgery. Bowel mechanical preparation and oral antibiotics are not a practice recommended in many clinical practice guides. The aim is to analyse the decrease in frequency and severity of postoperative complications, mainly related to anastomotic leak, after the establishment of a bundle.MethodsSingle-center, before-after study. A bundle was implemented to reduce anastomotic leaks and their consequences. The Bundle group were matched to Pre-bundle group by propensity score matching. Mechanical bowel preparation, oral and intravenous antibiotics, inflammatory markers measure and early diagnosis algorithm were included at the bundle.ResultsThe bundle group shown fewer complications, especially in Clavien Dindós Grade IV complications (2.3% vs. 6.2% p < 0.01), as well as a lower rate of anastomotic leakage (15.5% vs. 2.2% p < 0.01). A significant decrease in reinterventions, less intensive unit care admissions, a shorter hospital stay and fewer readmissions were also observed. In multivariate analysis, the application of a bundle was an anastomotic leakage protective factor (OR 0.121, p > 0.05)ConclusionsThe implementation of our bundle in colorectal surgery which include oral antibiotics, mechanical bowel preparation and inflammatory markers, significantly reduces morbidity adjusted to severity of complications, the anastomotic leakage rate, hospital stay and readmissions.Register studyThe study has been registered at clinicaltrials.gov Code: nct04632446.

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Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection: an international, multi‐centre, prospective audit

Cited by 48 publications

References 30 publications

Oral Antibiotic Prophylaxis Reduces Surgical Site Infection and Anastomotic Leakage in Patients Undergoing Colorectal Cancer Surgery

Oral Antibiotic Prophylaxis Reduces Surgical Site Infection and Anastomotic Leakage in Patients Undergoing Colorectal Cancer Surgery

Mechanical bowel preparation and antibiotics in elective colorectal surgery: network meta-analysis

Bundles reduce anastomosis leak in patients undergoing elective colorectal surgery. A propensity score-matched study

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