Effect of Preoperative Antibiotic Regimen on Development of Infection after Intestinal Surgery

Ja, Washington; Wh, Dearing; Es, Judd; Lr, Elveback

doi:10.1097/00000658-197410000-00021

Cited by 158 publications

(33 citation statements)

References 14 publications

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“…Small follow-up reports with different combinations of oral antibiotics (varying amounts of aerobic and anaerobic bacteria coverage) demonstrated that this treatment resulted in marked decontamination of the colon and decreased SSI. Washington et al conducted the first randomized trial comparing oral neomycin/tetracycline plus mechanical bowel preparation with placebo plus mechanical bowel preparation and demonstrated decreased infectious complications in group receiving oral antibiotics (43 % placebo, 41 % neomycin, 5 % neomycin and tetracycline) [ 27 ]. Subsequent work by Nichols, Condon, and Clark popularized the use of neomycin and erythromycin with mechanical bowel preparation [ 28 , 29 ].…”

Section: Mechanical Bowel Preparation With Oral Antibiotics For Colormentioning

confidence: 99%

Surgical Site Infection Prevention

Wick

Efron

2015

The SAGES / ERAS® Society Manual of Enhanced Recovery Programs for Gastrointestinal Surgery

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Surgical site infections (SSI) are the leading surgical complication with rates varying based on procedure, ranging from <1 % to upwards of 20 %. It is estimated that SSI cost an estimated $1 billion annually [ 1 -3 ]. SSI are associated with increased morbidity and are a leading risk factor for readmission during the 30-day period after hospital discharge [ 4 ]. In addition to patient harm, SSI are associated with increased health care use, such as increased length of hospital stay, doctor visits, use of wound care supplies, and home care. Increasingly, SSI and readmission are being used as a quality metric in surgical care by the Centers for Medicare and Medicaid Services and other payers with mandatory reporting of SSI rates after colon and hysterectomy surgery being mandated in January 2013 with anticipated impact on reimbursement in 2015.SSI prevention has been a challenge with the complexity of surgical patients and the perioperative care arena. There continues to be a need for well-designed randomized controlled trials to evaluate best practices for SSI prevention. Emerging evidence does support the implementation of bundled interventions to reduce SSI risk. Bundle elements vary slightly depending on the procedure, but core elements to consider including are: skin preparation; bowel preparation with oral antibiotics; pre-and intraoperative antibiotic use; use of wound protectors; laparoscopy; glucose control; fluid restriction; and temperature management. The evidence to support these interventions is elaborated on in this chapter.

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Section: Mechanical Bowel Preparation With Oral Antibiotics For Colormentioning

confidence: 99%

Surgical Site Infection Prevention

Wick

Efron

2015

The SAGES / ERAS® Society Manual of Enhanced Recovery Programs for Gastrointestinal Surgery

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“…Randomized prospective trials and meta-analyses comparing mechanical bowel cleansing with purgatives to no mechanical cleansing filled the pages of surgical journals around the world with little attention to history. Doctor Fry presented the results of several studies demonstrating oral antibiotics with mechanical bowel preparation, in addition to systemic antibiotics, reduce rates of both anastomotic leak and surgical site infection [28,29]. Doctor Fry commented that we have created our own revisionist history on the rationale and efficacy of bowel preparation prior to gastrointestinal surgery and as such, have assumed mistakenly we have reached equipoise over which regimens (bowel prep, no bowel prep, oral antibiotics, no oral antibiotics) are best.…”

Section: Doctor Donald Fry Presentationmentioning

confidence: 99%

Proceedings of the First International Summit on Intestinal Anastomotic Leak, Chicago, Illinois, October 4–5, 2012

Shogan

Schardey³

et al. 2014

Surgical Infections

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Objective: The first international summit on anastomotic leak was held in Chicago in October, 2012 to assess current knowledge in the field and develop novel lines of inquiry. The following report is a summary of the proceedings with commentaries and future prospects for clinical trials and laboratory investigations. Background: Anastomotic leakage remains a devastating problem for the patient, and a continuing challenge to the surgeon operating on high-risk areas of the gastrointestinal tract such as the esophagus and rectum. Despite the traditional wisdom that anastomotic leak is because of technique, evidence to support this is weak-to-non-existent.Outcome data continue to demonstrate that expert high-volume surgeons working in high-volume centers continue to experience anastomotic leaks and that surgeons cannot predict reliably which patients will leak. Methods: A one and one-half day summit was held and a small working group assembled to review current practices, opinions, scientific evidence, and potential paths forward to understand and decrease the incidence of anastomotic leak. Results: Results of a survey of the opinions of the group demonstrated that the majority of participants believe that anastomotic leak is a complicated biologic problem whose pathogenesis remains ill-defined. The group opined that anastomotic leak is underreported clinically, it is not because of technique except when there is gross inattention to it, and that results from animal models are mostly irrelevant to the human condition. Conclusions: A fresh and unbiased examination of the causes and strategies for prevention of anastomotic leak needs to be addressed by a continuous working group of surgeons, basic scientists, and clinical trialists to realize a real and significant reduction in its incidence and morbidity. Such a path forward is discussed.

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“…Furthermore, all of these antimicrobials when used in combination with either neomycin or kanamycin have been shown to reduce significantly the incidence of wound sepsis in colorectal surgery (Nichols et al, 1973;Washington et al, 1974;Goldring et al, 1975).…”

Section: Use Of Intraluminal Antibiotics In Bowel Preparationmentioning

confidence: 99%

Prevention of wound sepsis in gastro-intestinal surgery

Keighley

1977

Journal of British Surgery

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After gastro-intestinal operations wound infection is usually caused by the inoculation of bacteria present within the intestinal tract into the incision during the surgical procedure. In theory, wound sepsis may be minimized by the following methods: (a) avoiding intestinal contamination of the incision; (b) altering the normal flora of the intestinal tract by adding oral antimicrobials to bowel preparation; (c) using topical or systemic prophylactic antibiotic administration for certain high-risk patients. The relative importance of these methods of prophylaxis is described.

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Effect of Preoperative Antibiotic Regimen on Development of Infection after Intestinal Surgery

Cited by 158 publications

References 14 publications

Surgical Site Infection Prevention

Surgical Site Infection Prevention

Proceedings of the First International Summit on Intestinal Anastomotic Leak, Chicago, Illinois, October 4–5, 2012

Prevention of wound sepsis in gastro-intestinal surgery

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