Oral Antibiotic Prophylaxis Lowers Surgical Site Infection in Elective Colorectal Surgery: Results of a Pragmatic Cohort Study in Catalonia.

Josep M Badia,David Parés,Enric Limón,Ana Vázquez,Miguel Pera,Members Of The Vincat Colorectal Surveillance Team ,Miriam Flores-Yelamos,Joaquín López-Contreras,Nares Arroyo-García,Miquel Pujol,Mireia Puig-Asensio

doi:10.3390/jcm10235636

Abstract

Background: The role of oral antibiotic prophylaxis (OAP) and mechanical bowel preparation (MBP) in the prevention of surgical site infection (SSI) after colorectal surgery is still controversial. The aim of this study was to analyze the effect of a bundle including both measures in a National Infection Surveillance Network in Catalonia. Methods: Pragmatic cohort study to assess the effect of OAP and MBP in reducing SSI rate in 65 hospitals, comparing baseline phase (BP: 2007–2015) with implementation phase (IP: 2016–2019). To compare the results, a logistic regression model was established. Results: Out of 34,421 colorectal operations, 5180 had SSIs (15.05%). Overall SSI rate decreased from 18.81% to 11.10% in BP and IP, respectively (OR 0.539, CI95 0.507–0.573, p < 0.0001). Information about bundle implementation was complete in 61.7% of cases. In a univariate analysis, OAP and MBP were independent factors in decreasing overall SSI, with OR 0.555, CI95 0.483–0.638, and OR 0.686, CI95 0.589–0.798, respectively; and similarly, organ/space SSI (O/S-SSI) (OR 0.592, CI95 0.494–0.710, and OR 0.771, CI95 0.630–0.944, respectively). However, only OAP retained its protective effect at both levels at multivariate analyses. Conclusions: oral antibiotic prophylaxis decreased the rates of SSI and O/S-SSI in a large series of elective colorectal surgery.

Highlights

Surgical site infections (SSI) are among the most common healthcare-related infections [1,2], and the most frequent postoperative complication
NNISS: National nosocomial infections surveillance system. * Adequate surgical prophylaxis: type of antibiotic according to local guidelines, in addition to correct timing, dosage and duration
Information was obtained on the application of the bundle measures, the level of adherence to each of the measures was variable, from 100% for systemic antibiotic prophylaxis or the use of laparoscopy, to 65% for application of oral antibiotic prophylaxis (OAP) or mechanical bowel preparation (MBP)

Summary

Introduction

Surgical site infections (SSI) are among the most common healthcare-related infections [1,2], and the most frequent postoperative complication. Some are exclusive to colorectal surgery, namely mechanical bowel preparation (MBP) and oral antibiotic prophylaxis (OAP). The beginning of the 21st century saw a decline in the use of mechanical and oral bowel preparation (MOABP) after several studies compared MBP against non-preparation [10,11], and demonstrated that omitting MBP did not increase complications in colon and rectal surgery. The role of oral antibiotic prophylaxis (OAP) and mechanical bowel preparation (MBP) in the prevention of surgical site infection (SSI) after colorectal surgery is still controversial. Methods: Pragmatic cohort study to assess the effect of OAP and MBP in reducing SSI rate in 65 hospitals, comparing baseline phase (BP: 2007–2015) with implementation phase (IP: 2016–2019). Conclusions: oral antibiotic prophylaxis decreased the rates of SSI and O/S-SSI in a large series of elective colorectal surgery

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