Preoperative Oral Antibiotics in Colorectal Surgery Increase the Rate of Clostridium difficile Colitis

Wren, Sherry M.; Ahmed, Natasha; Jamal, Ayesha; Safadi, Bassem Y.

doi:10.1001/archsurg.140.8.752

Cited by 127 publications

(75 citation statements)

References 12 publications

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“…Since the use of broad-spectrum antibiotic prophylaxis may lead to bacterial resistance [31] , fungal infections [32] , selective overgrowth of pathogens leading to, for instance, Clostridium difficile colitis [33] and increased costs [34] , the balance between beneficial and harmful effects of antibiotic prophylaxis should clearly be in favor of antibiotics in order to justify their use. The current meta-analysis demonstrated no beneficial effects of antibiotic prophylaxis on the incidence of both infected pancreatic necrosis and mortality.…”

Section: Discussionmentioning

confidence: 99%

Randomized Controlled Trials of Antibiotic Prophylaxis in Severe Acute Pancreatitis: Relationship between Methodological Quality and Outcome

Vries

Besselink

Buskens³

et al. 2007

Pancreatology

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Aim: To evaluate the methodological quality of randomized controlled trials (RCTs) of systemic antibiotic prophylaxis in severe acute pancreatitis in relation to outcome. Methods: The MEDLINE, EMBASE and Cochrane databases were searched for RCTs that studied the effectiveness of systemic antibiotic prophylaxis in severe acute pancreatitis. A meta-analysis was performed with a random effects model. Methodological quality was quantified by a previously published scoring system (range 0–17 points). Results: Six studies, with a total of 397 participants, obtained a methodological score of at least 5 points and were included. Systemic antibiotic prophylaxis had no significant effect on infection of pancreatic necrosis (absolute risk reduction (ARR) 0.055; 95% CI –0.084 to 0.194) and mortality (ARR 0.058, 95% CI –0.017 to 0.134). Spearman correlation showed an inverse association between methodological quality and ARR for mortality (correlation coefficient –0.841, p = 0.036). Conclusions: The inverse relationship between methodological quality and impact of antibiotic prophylaxis on mortality emphasizes the importance of high-quality RCTs. At present, adequate evidence for the routine use of antibiotic prophylaxis in severe acute pancreatitis is lacking.

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Section: Discussionmentioning

confidence: 99%

Randomized Controlled Trials of Antibiotic Prophylaxis in Severe Acute Pancreatitis: Relationship between Methodological Quality and Outcome

Vries

Besselink

Buskens³

et al. 2007

Pancreatology

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“…The disruption of the normal colonic flora by the use of mechanical bowel preparation or the use of preoperative oral antibiotics was not associated with an increased incidence of C. difficile infection in some studies [21], while others showed a higher rate of infection [22] or no significant difference [23]. A recent study suggested that the prevalence of C. difficile colonization is high in preoperative colorectal cancer patients, and the colonization is not acquired in the hospital.…”

Section: Discussionmentioning

confidence: 98%

“…New treatment strategies that reduce the toxicity of already-bound toxin, or prevent toxin binding to the colon, are needed [5]. The alternative treatment using calcium aluminosilicate uniform particle has proven effective in vitro by sequestering toxins A and B to undetectable levels [11].The disruption of the normal colonic flora by the use of mechanical bowel preparation or the use of preoperative oral antibiotics was not associated with an increased incidence of C. difficile infection in some studies [21], while others showed a higher rate of infection [22] or no significant difference [23]. A recent study suggested that the prevalence of C. difficile colonization is high in preoperative colorectal cancer patients, and the colonization is not acquired in the hospital.…”

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confidence: 99%

Clostridium Difficile Infection - An Optimistic View

Frunza¹,

Rotundu²,

Morărașu³

et al. 2017

Surgery

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Journal of Surgery IntroductionClostridium difficile is an anaerobic, Gram-positive, spore-forming, toxin-producing bacteria identified as a cause of colitis associated with antibiotic use [1]. Previous exposure to antibiotics is the most important risk factor for CDI, leading to modification of the normal flora of the colon and decreasing the intestine's resistance to colonization [2]. Other risk factors for CDI are inflammatory bowel disease, immunodeficiency, hypoalbuminemia, malignancies, organ transplantation and mechanical bowel preparation. Despite the development of CDI therapy there is a growing incidence, severity, mortality and recurrence of this condition [3]. The high rate of recurrent CDI raises a question mark over current treatment recommendations of the first episodes of CDI [4,5]. Materials and MethodsWe identified all reported cases of CDI during the period of 2014-2016 using the digital database of the center for control, surveillance, and prevention of transmissible diseases in the Regional Oncologic Institute Iasi. All cases are registered in the database immediately after diagnosis, followed by epidemiological investigation and standardized protocols for isolation and protection of contacts. The admission charts were studied to extract the following information: age, sex, date of admission and release, date of CDI confirmation and toxin negativity. We also checked for antibiotic use in the last 3 months, administration of gastricantisecretory medication, previous hospitalization or contact with CDIconfirmed patients. For the surgical cases we gathered data about the date and type of intervention performed. Diagnosis of Clostridium difficile colitisEven if symptoms can be variable, typical symptom is watery diarrhea up to 15-30 stools per day [1,3]. Some patients can complain AbstractBackground: Clostridium difficile infection (CDI) is one of the most common infectious complications affecting vulnerable patients, i.e., after surgery or immunosuppressive therapies, posing a significant risk in an oncological unit. Materials and methods:We analyzed data recovered from 164 cases of CDI during the period of 2014-2016 in the Regional Oncologic Institute Iasi, majority admitted in the surgical and hematological units. In all cases diagnostic was confirmed if stool samples tested positive for GDH and at least one of the toxins A or B. Results:The study shows a large population of elder patients (median age 64 years) with female dominance (54%). Out of 117 surgical cases 64% had surgical procedures on the gastro-intestinal tract. Although 20% of patients had equivocal symptoms from admission, the average interval (from admission) until first symptoms developed was 7 days. The confirmation of the diagnosis came in the next day/24h in 68% of cases, leading to initiation of efficient therapy. Although CDI is regarded as an antibiotic associated disease, our data revealed that only one third of patients received antibiotic treatment in the last 3 months. Among the risk factors that may have an influen...

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“…La letteratura è univoca nel considerare le CDI sequele del trattamento antibiotico [2,4,10,38,39,[42][43][44][45][46][52][53][54] e antisecretivo gastrico [47][48][49][50][52][53][54], singoli o associati, e dello status nutrizionale-immunologico del paziente [55,56].…”

Section: Discussioneunclassified

“…viduati numerosi fattori di rischio quali età [37,38], impegno clinico [2,4,10,38,39], durata del ricovero [40,41], assetto nutrizionale e soprattutto terapia antibiotica [42][43][44][45][46], impiego degli inibitori di pompa protonica [47][48][49][50] (Proton Pump Inhibitors -PPI), ricovero in strutture sanitarie riabilitative o per lungodegenti [51]. La storia naturale dell'infezione intestinale da C. difficile è ben conosciuta [52][53][54].…”

Section: Introduzioneunclassified

Fidaxomicin in the treatment of colitis due to Clostridium difficile: preliminary results

Cortese

Meledandri

Ballardini

et al. 2014

CMI

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5y sostenute, anche nello stesso ambito ospedaliero, da ceppi batterici differenti anche con diversa virulenza [21][22][23][24][25]; y complicanze di percorsi clinici intensivi, chirurgici, internistici spesso combinati tra loro [26][27][28][29][30][31][32]; y caratterizzate dalla necessità di intraprendere misure ospedaliere logistiche articolate come l'isolamento dei pazienti [33,34]; y causa di incremento dei costi di ricovero [35,36]. La CDI non è quasi mai un'infezione de novo, ma colpisce soggetti con patologie attive o nel decorso di procedure diagnosticooperative spesso articolate. Sono stati indi- INTRODUZIONEClostridium difficile è un bacillo Gram-positivo, anaerobio e sporigeno. La sua azione patogena si esplica nel 99% dei casi nella colite [1], che configura la Clostridium difficile Infection (CDI) [2][3][4]. Questa condizione rappresenta una vera e propria sindrome in costante e importante incremento in tutto il mondo occidentale [5][6][7][8][9]. Le CDI sono: y nella stragrande maggioranza dei casi infezioni nosocomiali di pazienti complessi nei quali aumentano morbilità e mortalità [10][11][12][13][14][15]; y causa di sindromi differenti con coefficienti di gravità diversi [16][17][18][19][20];

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Preoperative Oral Antibiotics in Colorectal Surgery Increase the Rate of Clostridium difficile Colitis

Cited by 127 publications

References 12 publications

Randomized Controlled Trials of Antibiotic Prophylaxis in Severe Acute Pancreatitis: Relationship between Methodological Quality and Outcome

Randomized Controlled Trials of Antibiotic Prophylaxis in Severe Acute Pancreatitis: Relationship between Methodological Quality and Outcome

Clostridium Difficile Infection - An Optimistic View

Fidaxomicin in the treatment of colitis due to Clostridium difficile: preliminary results

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