Impact of oral antibiotic prophylaxis on surgical site infection after rectal surgery: results of randomized trial

Rybakov, E. G.; Нагудов, М. А.; Сухина, М. А.; Shelygin, Yuri

doi:10.1007/s00384-020-03746-0

Cited by 17 publications

(8 citation statements)

References 21 publications

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“…116 In 2021, 117 the metaanalysis was updated to include the results from the MOBILE and ORALEV trials, which further demonstrated the decreases shown in 2019, 119,120 along with data showing that oral antimicrobial prophylaxis alone without mechanical bowel preparation significantly reduces SSI, anastomotic leak, and 30-day mortality. 121,122 We continue to recommend the combination of parenteral and oral antimicrobial prophylaxis and mechanical bowel preparation prior to elective colorectal surgery, unless there is a contraindication to mechanical bowel preparation, in which case, only parenteral and oral antimicrobial prophylaxis should be administered. b.…”

Section: Education Of Patients and Families Provide Education Formentioning

confidence: 99%

“…116 In 2021, 117 the meta-analysis was updated to include the results from the MOBILE and ORALEV trials, which further demonstrated the decreases shown in 2019, 119,120 along with data showing that oral antimicrobial prophylaxis alone without mechanical bowel preparation significantly reduces SSI, anastomotic leak, and 30-day mortality. 121,122 We continue to recommend the combination of parenteral and oral antimicrobial prophylaxis and mechanical bowel preparation prior to elective colorectal surgery, unless there is a contraindication to mechanical bowel preparation, in which case, only parenteral and oral antimicrobial prophylaxis should be administered. Use of combination parenteral and oral antimicrobial agents to reduce the risk of SSI should be considered in any surgical procedure where entry into the colon is possible or likely, as in gynecologic oncology surgery. Mechanical bowel preparation without use of oral antimicrobial agents does not decrease the risk of SSI. 115 A recent prospective randomized multicenter trial confirmed earlier meta-analysis findings, with significantly higher SSI and anastomotic leakage in patients who received mechanical bowel preparation without oral antimicrobial agents.…”

Section: Section 4: Recommended Strategies To Prevent Ssimentioning

confidence: 99%

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Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update

Calderwood

Anderson

Bratzler

et al. 2023

Infect. Control Hosp. Epidemiol.

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and purpose The intent of this document is to highlight practical recommendations in a concise format designed to assist acute-care hospitals in implementing and prioritizing their surgical-site infection (SSI) prevention efforts. This document updates the Strategies to Prevent Surgical Site Infections in Acute Care Hospitals published in 2014.1 This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.

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Section: Education Of Patients and Families Provide Education Formentioning

confidence: 99%

Section: Section 4: Recommended Strategies To Prevent Ssimentioning

confidence: 99%

Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update

Calderwood

Anderson

Bratzler

et al. 2023

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

show abstract

“…They therefore recommended the routine administration of OAP on the day before colorectal surgery. More recently, a 2021 single-centre RCT of 116 patients by Rybakov et al also noted significantly reduced risk of SSI with the use of OAP and IV antibiotics at induction compared to IV antibiotics alone [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

The Use of Mechanical Bowel Preparation and Oral Antibiotic Prophylaxis in Elective Colorectal Surgery: A Call for Change in Practice

Petrou

Kontovounisios

2022

Cancers

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Elective colorectal surgery is associated with one of the highest rates of surgical site infections (SSIs), which result in prolonged length of stay, morbidity, and mortality for these patients and have a significant financial burden to healthcare systems. In an effort to reduce the frequency of SSI rates associated with colorectal surgery, the 2018 World Health Organisation (WHO) guidelines recommend the routine use of mechanical bowel preparation (MBP) and oral antibiotic prophylaxis (OAP) in adult patients undergoing elective colorectal surgery. However, this recommendation remains a topic of debate internationally. The National Institute of Clinical Excellence (NICE) guidelines, last revised in 2019, recommend against the routine use of MBP and do not address the issue of OAP. In this communication, we reviewed the current guidelines and examined the most recent evidence from randomised-control trials (RCTs) and meta-analyses on the effect of MBP and OAP on SSI rates since the 2019 NICE guideline review. This recent evidence clearly demonstrated an SSI-risk-reduction benefit with the additional use of OAP and the combination of MBP and OAP in this group of patients, and we therefore highlight the need for change of the current NICE guidelines.

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“…The study reported a statistical difference in in SSIs favouring MOABP, but the study included only 116 patients, metronidazole was not included in the intravenous antibiotic prophylaxis, the study was not blinded and patients with no bowel anastomosis were included. 28 The SELECT trial compared prospectively selective decontamination of digestive tract (SDD) with an oral suspension containing amphotericin B, colistin sulphate and tobramycin to no decontamination. 29 The patients with left colectomy received MBP, but patients undergoing right colectomy did not.…”

Section: Discussionmentioning

confidence: 99%

Mechanical bowel preparation and oral antibiotics versus mechanical bowel preparation only prior rectal surgery (MOBILE2): a multicentre, double-blinded, randomised controlled trial—study protocol

et al. 2021

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IntroductionMechanical bowel preparation (MBP) prior to rectal surgery is widely used. Based on retrospective data many guidelines recommend mechanical and oral antibiotic bowel preparation (MOABP) to reduce postoperative complications and specifically surgical site infections (SSIs). The primary aim of this study is to examine whether MOABP reduces complications of rectal surgery.Methods and analysisThe MOBILE2 (Mechanical Bowel Preparation and Oral Antibiotics vs Mechanical Bowel Preparation Only Prior Rectal Surgery) trial is a multicentre, double-blinded, parallel group, superiority, randomised controlled trial comparing MOABP to MBP among patients scheduled for rectal surgery with colorectal or coloanal anastomosis. The patients randomised to the MOABP group receive 1 g neomycin and 1 g metronidazole two times on a day prior to surgery and patients randomised to the MBP group receive identical placebo. Based on power calculations, 604 patients will be enrolled in the study. The primary outcome is Comprehensive Complication Index within 30 days after surgery. Secondary outcomes are SSIs within 30 days after surgery, the number and classification of anastomosis dehiscences, the length of hospital stay, mortality within 90 days after surgery and the number of patients who received adjuvant treatment if needed. Tertiary outcomes are overall survival, disease-specific survival, recurrence-free survival and difference in quality-of-life before and 1 year after surgery. In addition, the microbiota differences in colon mucosa are analysed.Ethics and disseminationThe Ethics Committee of Helsinki University Hospital approved the study. The findings will be disseminated in peer-reviewed academic journals.Trial registration numberNCT04281667.

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Impact of oral antibiotic prophylaxis on surgical site infection after rectal surgery: results of randomized trial

Cited by 17 publications

References 21 publications

Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update

Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update

The Use of Mechanical Bowel Preparation and Oral Antibiotic Prophylaxis in Elective Colorectal Surgery: A Call for Change in Practice

Mechanical bowel preparation and oral antibiotics versus mechanical bowel preparation only prior rectal surgery (MOBILE2): a multicentre, double-blinded, randomised controlled trial—study protocol

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