Effect of Inclusion of Oral Antibiotics with Mechanical Bowel Preparation on the Risk of Clostridium Difficile Infection After Colectomy

Abstract

The use of OA as bowel preparation may reduce, rather than increase, the risk of 30-day CDI after colectomy. This effect may partly be due to the other recovery advantages associated with oral antibiotics. These data further support current data recommending the use of oral antibiotics for bowel preparation before colectomy.

The use of oral antibiotics and mechanical bowel preparation in elective colorectal resection for the reduction of surgical site infection

“…Kim et al showed that patients having MOAB had a lower CDI rate than those with no bowel preparation (0.5% vs 1.8%, P = 0.01) while Al‐Mazrou et al . showed a similar reduction with OAB alone. The majority of studies show no differences in CDI rates in patients exposed to OAB.…”

“…Only two published studies show an increase in CDI rates [57] or readmissions due to CDI [18], whereas two retrospective studies show a beneficial effect. Kim et al [19] showed that patients having MOAB had a lower CDI rate than those with no bowel preparation (0.5% vs 1.8%, P = 0.01) while Al-Mazrou et al [58] showed a similar reduction with OAB alone. The majority of studies show no differences in CDI rates in patients exposed to OAB.…”

Sustained positive impact of ACS-NSQIP program on outcomes after colorectal surgery over the last decade

“…15 Such a perioperative protocol was preventive against Clostridium Difficile infection after surgery in other analyses. 15,16,17 Therefore, the adoption of oral antibiotics by ACS-NSQIP hospitals doubled between 2012 10 and 2016. 17 Based on these findings, current colorectal surgery practice guidelines recommend such an approach in routine practice.…”

Colorectal surgery and preoperative bowel preparation: aren't we drawing hasty conclusions?

“…Eleven studies [6][7][8][9][10][11][12][13][14][15][16] have used the ACS NSQIP data to assess the impact of MBP + OA in colorectal surgery (Table 1). In most studies [6][7][8][9][10][11][12][13][14], the primary end-point was the 30-day morbidity or the 30-day surgical site infection (SSI) rates: all found superiority of MBP + OA over no preparation.…”

“…In the mid-2000s, most leading surgical societies assumed that mechanical bowel preparation (MBP) was not indicated in colonic surgery [1][2][3][4] and was restricted to rectal surgery [1,5]. However, since 2015, several large nationwide American studies [6][7][8][9][10][11][12][13][14][15][16] have challenged these notions, finding concordant benefits of a combination of MBP and oral antibiotics (OA) in both colonic and rectal surgery. As a result, the 2017 joint guidelines of the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons recommended a combination of MBP and OA in colorectal surgery [17].…”