Randomized, Multicenter Trial of Antibiotic Prophylaxis in Elective Colorectal Surgery

Fujita, Shin

doi:10.1001/archsurg.142.7.657

Cited by 88 publications

(34 citation statements)

References 28 publications

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“…Randomized studies have compared the efficacy of different types [11-13] or doses [14,15] of systemic antibiotics for preventing SSIs; influence of different preoperative skin antisepsis agents was also investigated [5]. To our knowledge, this is the first randomized controlled trial addressing the efficacy of an ionic-silver-delivering antimicrobial dressing in lowering the SSI rate of patients having colorectal cancer elective open surgery.…”

Section: Discussionmentioning

confidence: 99%

Surgical site infections following colorectal cancer surgery: a randomized prospective trial comparing common and advanced antimicrobial dressing containing ionic silver

et al. 2012

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BackgroundAn antimicrobial dressing containing ionic silver was found effective in reducing surgical-site infection in a preliminary study of colorectal cancer elective surgery. We decided to test this finding in a randomized, double-blind trial.MethodsAdults undergoing elective colorectal cancer surgery at two university-affiliated hospitals were randomly assigned to have the surgical incision dressed with Aquacel® Ag Hydrofiber dressing or a common dressing. To blind the patient and the nursing and medical staff to the nature of the dressing used, scrub nurses covered Aquacel® Ag Hydrofiber with a common wound dressing in the experimental arm, whereas a double common dressing was applied to patients of control group. The primary end-point of the study was the occurrence of any surgical-site infection within 30 days of surgery.ResultsA total of 112 patients (58 in the experimental arm and 54 in the control group) qualified for primary end-point analysis. The characteristics of the patient population and their surgical procedures were similar. The overall rate of surgical-site infection was lower in the experimental group (11.1% center 1, 17.5% center 2; overall 15.5%) than in controls (14.3% center 1, 24.2% center 2, overall 20.4%), but the observed difference was not statistically significant (P = 0.451), even with respect to surgical-site infection grade 1 (superficial) versus grades 2 and 3, or grade 1 and 2 versus grade 3.ConclusionsThis randomized trial did not confirm a statistically significant superiority of Aquacel® Ag Hydrofiber dressing in reducing surgical-site infection after elective colorectal cancer surgery.Trial registrationClinicaltrials.gov: NCT00981110

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Section: Discussionmentioning

confidence: 99%

Surgical site infections following colorectal cancer surgery: a randomized prospective trial comparing common and advanced antimicrobial dressing containing ionic silver

et al. 2012

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“…However, there is still a debate about the duration of the antibiotic treatment and the kind of antibiotic which should be used. In summary, most studies favour one to three intravenous doses of a second generation cephalosporine with or without metronidazole with the first dose being administered before skin incision [109,110]. …”

Section: Complicationsmentioning

confidence: 99%

Complications in colorectal surgery: risk factors and preventive strategies

2010

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BackroundOpen or laparoscopic colorectal surgery comprises of many different types of procedures for various diseases. Depending upon the operation and modifiable and non-modifiable risk factors the intra- and postoperative morbidity and mortality rate vary. In general, surgical complications can be divided into intraoperative and postoperative complications and usually occur while the patient is still in the hospital.MethodsA literature search (1980-2009) was carried out, using MEDLINE, PubMed and the Cochrane library.ResultsThis review provides an overview how to identify and minimize intra- and postoperative complications. The improvement of different treatment strategies and technical inventions in the recent decade has been enormous. This is mainly attributable to the increase in the laparoscopic approach, which is now well accepted for many procedures. Training of the surgeon, hospital volume and learning curves are becoming increasingly more important to maximize patient safety, surgeon expertise and cost effectiveness. In addition, standardization of perioperative care is essential to minimize postoperative complications.ConclusionThis review summarizes the main perioperative complications of colorectal surgery and influencable and non-influencable risk factors which are important to the general surgeon and the relevant specialist as well. In order to minimize or even avoid complications it is crucial to know these risk factors and strategies to prevent, treat or reduce intra- and postoperative complications.

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“…There were two important randomized trials [26, 27] from Japan that have compared the risks of SSIs following single-dose intravenous antimicrobial prophylaxis [26] and preoperative chemical preparation [27] in patients undergoing elective colorectal surgery. Fujita et al [26] reported that single-dose intravenous prophylaxis was associated with a >3-fold increase in the overall incidence of SSIs (14.3 vs. 4.3 %) compared to triple-dose intravenous antimicrobial prophylaxis in patients undergoing elective colorectal cancer surgery who had undergone mechanical cleansing, but not chemical preparation, preoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…Fujita et al [26] reported that single-dose intravenous prophylaxis was associated with a >3-fold increase in the overall incidence of SSIs (14.3 vs. 4.3 %) compared to triple-dose intravenous antimicrobial prophylaxis in patients undergoing elective colorectal cancer surgery who had undergone mechanical cleansing, but not chemical preparation, preoperatively. They did not analyze the results separately in patients undergoing colon cancer surgery and rectal cancer surgery.…”

Section: Discussionmentioning

confidence: 99%

Short-term intravenous antimicrobial prophylaxis for elective rectal cancer surgery: results of a prospective randomized non-inferiority trial

et al. 2013

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PurposeTo investigate the non-inferiority of postoperative single-dose intravenous antimicrobial prophylaxis to multiple-dose intravenous antimicrobial prophylaxis in terms of the incidence of surgical site infections (SSIs) in patients undergoing elective rectal cancer surgery by a prospective randomized study.MethodsPatients undergoing elective surgery for rectal cancer were randomized to receive a single intravenous injection of flomoxef (group 1) or five additional doses (group 2) of flomoxef after the surgery. All the patients had received preoperative oral antibiotic prophylaxis (kanamycin and erythromycin) after mechanical cleansing within 24 h prior to surgery, and had received intravenous flomoxef during surgery.ResultsA total of 279 patients (including 139 patients in group 1 and 140 in group 2) were enrolled in the study. The incidence of SSIs was 13.7 % in group 1 and 13.6 % in group 2 (difference [95 % confidence interval]: −0.2 % [−0.9 to 0.7 %]).ConclusionThe incidence of SSIs was not significantly different in patients undergoing elective rectal surgery who were treated using a single dose of postoperative antibiotics compared to those treated using multiple-dose antibiotics when preoperative mechanical and chemical bowel preparations were employed.

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Randomized, Multicenter Trial of Antibiotic Prophylaxis in Elective Colorectal Surgery

Cited by 88 publications

References 28 publications

Surgical site infections following colorectal cancer surgery: a randomized prospective trial comparing common and advanced antimicrobial dressing containing ionic silver

Surgical site infections following colorectal cancer surgery: a randomized prospective trial comparing common and advanced antimicrobial dressing containing ionic silver

Complications in colorectal surgery: risk factors and preventive strategies

Short-term intravenous antimicrobial prophylaxis for elective rectal cancer surgery: results of a prospective randomized non-inferiority trial

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