Role of oral antibiotics for prophylaxis against surgical site infections after elective colorectal surgery

Abstract

Over the past few decades, surgeons have made many attempts to reduce the incidence of surgical site infections (SSI) after elective colorectal surgery. Routine faecal diversion is no longer practiced in elective colonic surgery and mechanical bowel preparation is on the verge of being eliminated altogether. Intravenous antibiotics have become the standard of care as prophylaxis against SSI for elective colorectal operations. However, the role of oral antibiotics is still being debated. We review the available data evaluating the role of oral antibiotics as prophylaxis for SSI in colorectal surgery.

Enhanced recovery after surgery in gynecologic oncology

“…On the contrary, mechanical preparations may cause dehydration and electrolyte and metabolic derangements. Retrospective studies have suggested, however, that nonabsorbable oral antibiotics, such as neomycin, may reduce the incidence of surgical site infections (RR 0.57; 95% CI 0.43–0.76) with no effect on organ space infections or anastomotic leaks, although most studies were performed in colorectal rather than gynecologic surgery . A meta‐analysis of mechanical bowel preparation versus oral antibiotic plus mechanical bowel preparation, showed that the combination was more effective in reducing total surgical site infections (16% vs 7.2%, P <0.001).…”

“…Retrospective studies have suggested, however, that nonabsorbable oral antibiotics, such as neomycin, may reduce the incidence of surgical site infections (RR 0.57; 95% CI 0.43-0.76) with no effect on organ space infections or anastomotic leaks, although most studies were performed in colorectal rather than gynecologic surgery. 12,13 A meta-analysis of mechanical bowel preparation versus oral antibiotic plus mechanical bowel preparation, 14 showed that the combination was more effective in reducing total surgical site infections (16% vs 7.2%, P<0.001). A recent ACS-NSQIP study of over 40 000 patients undergoing colorectal surgery showed that oral antibiotics alone were as good as a combination of antibiotic and mechanical bowel preparation.…”

Evaluation of the short‐term complications of intracorporeal anastomosis in right‐sided colectomy

“…Few studies have reported the extent to which bacterial exposure contributes to increased postoperative fever and inflammatory responses. SSIs, such as wound infections and intra‐abdominal abscesses, pose various challenges such as wound management, prolonged hospitalization, and increased medical costs 8–13 …”

“…SSIs, such as wound infections and intra-abdominal abscesses, pose various challenges such as wound management, prolonged hospitalization, and increased medical costs. [8][9][10][11][12][13] Various measures have been developed to minimize intraperitoneal contamination, including chemical preparation and anastomosis. 10 However, no studies have provided detailed information on intraoperative contamination.…”

“…[8][9][10][11][12][13] Various measures have been developed to minimize intraperitoneal contamination, including chemical preparation and anastomosis. 10 However, no studies have provided detailed information on intraoperative contamination. Therefore, we aimed to investigate the short-term postoperative outcomes of IA in right-sided colectomy.…”