Abstract
Standard surgical antimicrobial prophylaxis (SAP) regimens are less effective in preventing surgical site infections (SSIs) due to rising antimicrobial resistance (AMR) rates, particularly for patients undergoing colorectal surgery. This study aimed to evaluate whether ertapenem should be a preferred strategy for the prevention of SSIs following elective colorectal surgery compared to three standard SAP regimens: amoxicillin-clavulanate, cefoxitin, and cefazolin plus metronidazole. A cost-effectiveness analysis was conducted using decision tree models. Probabilities of SSIs and AMR-SSIs, costs, and effects (in terms of quality-adjusted life-years) were considered in the assessment of the alternative strategies. Input parameters integrated real data from the Italian surveillance system for SSIs with data from the published literature. A sensitivity analysis was conducted to assess the potential impact of the decreasing efficacy of standard SAP regimens in preventing SSIs. According to our models, ertapenem was the most cost-effective strategy only when compared to amoxicillin-clavulanate, but it did not prove to be superior to cefoxitin and cefazolin plus metronidazole. The sensitivity analysis found ertapenem would be the most cost-effective strategy compared to these agents if their failure rate was more than doubled. The findings of this study suggest ertapenem should not be a preferred strategy for SAP in elective colorectal surgery.
Highlights
The emergence of antimicrobial resistant (AMR) pathogens and its impact on the treatment of infections is raising concern about the negative effect antimicrobial resistance (AMR) might have on the efficacy of standard surgical antimicrobial prophylaxis (SAP) regimens in preventing surgical site infections (SSIs), for patients undergoing colorectal surgery [1]
This study aimed to evaluate whether ertapenem should be a preferred strategy for the prevention of SSIs following elective colorectal surgery compared to three standard SAP regimens: amoxicillin-clavulanate, cefoxitin, and cefazolin plus metronidazole
The sensitivity analysis found ertapenem would be the most cost-effective strategy compared to these agents if their failure rate was more than doubled
Summary
The emergence of antimicrobial resistant (AMR) pathogens and its impact on the treatment of infections is raising concern about the negative effect AMR might have on the efficacy of standard surgical antimicrobial prophylaxis (SAP) regimens in preventing surgical site infections (SSIs), for patients undergoing colorectal surgery [1]. A meta-analysis of 39 randomized controlled trials conducted between 1981 and 2006, in which cefoxitin, cefotetan or cefazolin plus metronidazole were used for SAP, found that the proportion of SSIs after colorectal surgery increased by 5% per year [3]. This trend could be explained by the parallel rise in bowel colonization with AMR bacteria, such as extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-PE) and Bacteroides spp resistant to cefoxitin and cefotetan [4,5,6]. Ertapenem is effective and widely used for acute abdominal conditions, such as acute appendicitis or diffuse peritonitis in the EU, ertapenem has not been used extensively for the prevention of SSIs after colorectal surgery out of concern that increasing the use of carbapenems will aggravate the levels of resistance to these agents [10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
