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

Abstract

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.

Comparative effectiveness of oral antibiotics, probiotics, prebiotics, and synbiotics in the prevention of postoperative infections in patients undergoing colorectal surgery: A network meta‐analysis

“…Synbiotics are defined as mixtures of probiotics and prebiotics that confer a health benefit on the host by improving the survival and activity of beneficial microorganisms in the gut 33 . Previous systematic reviews and meta‐analyses focused on examine the effectiveness of probiotics and antibiotics separately, and these studies confirmed that probiotics and synbiotics used perioperatively decreased the incidence of SSI, 7‐9 and they also confirmed that preoperative administration of OAB was associated with lower incidence of SSI 1,2,4,6 . Our study was the first to compare probiotic treatments with OAB, and the results showed that pretreatment with OAB was a better option for reducing infection rate and anastomotic leakage rate.…”

“…Sepsis is still a lethal complication after abdominal surgery, although surgical techniques, and perioperative management have been prominently improved. Surgical site infection (SSI) is the most essential factor leading to sepsis, and SSI is prevalent in elective colorectal surgery, which occurs in 20% of the patients receiving colorectal surgery 1 . Prevention of SSI is therefore a job of the first order in postoperative management.…”

“…Surgical site infection (SSI) is the most essential factor leading to sepsis, and SSI is prevalent in elective colorectal surgery, which occurs in 20% of the patients receiving colorectal surgery. 1 Prevention of SSI is therefore a job of the first order in postoperative management. The use of intravenous antibiotics (IAB) after surgery is proposed for preventing SSI, but it raises concerns about antimicrobial resistance.…”

“…Surgical site infection (SSI) is the most essential factor leading to sepsis, and SSI is prevalent in elective colorectal surgery, which occurs in 20% of the patients receiving colorectal surgery. 1 Prevention of SSI is therefore a job of the first order in postoperative management.…”

A risk prediction model associated with postoperative diarrhea in colorectal cancer patients

“…Our study revealed that the type of antibiotic was signi cantly associated with diarrhea after surgery treatment. Nowadays, the prophylactic use of antibiotics in abdominal surgery has been widely recognized, which can signi cantly reduce the incidence of surgical site infection and anastomotic leakage [26][27]. However, the abuse of antibiotics disrupts the symbiotic ecology of the intestinal tract, inhibits bene cial ora, and leads to a decrease in intestinal resistance to colonization and a continuous proliferation of pathogenic bacteria [28][29].…”