Oral Antibiotic Prophylaxis Reduces Surgical Site Infection and Anastomotic Leakage in Patients Undergoing Colorectal Cancer Surgery.

Simran Grewal,René H J Otten,Gabor S A Abis,Marjolein Van Egmond,Geert Kazemier,Hein B A C Stockmann,Steven J Oosterling,J Reinder D Reuvers

doi:10.3390/biomedicines9091184

Simran Grewal, René H J Otten + Show 6 more

Open Access

https://doi.org/10.3390/biomedicines9091184

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Abstract

Background: Surgical-site infection (SSI) and anastomotic leakage (AL) are major complications following surgical resection of colorectal carcinoma (CRC). The beneficial effect of prophylactic oral antibiotics (OABs) on AL in particular is inconsistent. We investigated the impact of OABs on AL rates and on SSI. Methods: A systematic review and meta-analysis of recent RCTs and cohort studies was performed including patients undergoing elective CRC surgery, receiving OABs with or without mechanical bowel preparation (MBP). Primary outcomes were rates of SSI and AL. Secondarily, rates of SSI and AL were compared in broad-spectrum OABs and selective OABs (selective decontamination of the digestive tract (SDD)) subgroups. Results: Eight studies (seven RCTs and one cohort study) with a total of 2497 patients were included. Oral antibiotics combined with MBP was associated with a significant reduction in SSI (RR = 0.46, 95% confidence interval (CI) 0.31–0.69), I2 = 1.03%) and AL rates (RR = 0.58, 95% CI 0.37–0.91, I2 = 0.00%), compared to MBP alone. A subgroup analysis demonstrated that SDD resulted in a significant reduction in AL rates compared to broad-spectrum OABs (RR = 0.52, 95% CI 0.30 to 0.91), I2 = 0.00%). Conclusion: OABs in addition to MBP reduces SSI and AL rates in patients undergoing elective CRC surgery and, more specifically, SDD appears to be more effective compared to broad-spectrum OABs in reducing AL.

Highlights

Colorectal carcinoma (CRC) surgery is still associated with significant infectious morbidity despite advances in recent decades in surgical techniques and antiseptic measures.With 1.8 million people diagnosed with CRC in 2018, this clinical problem remains a serious issue in surgical healthcare [1]
The vast majority of Surgical site infection (SSI) are caused by endogenous bacteria residing in the digestive tract, of which potentially pathogenic microorganisms (PPMs) account for most hospitalacquired infections [6,7]
Primary inclusion criteria were met in 60 studies, which were subsequently reviewed in detail

Summary

Introduction

Colorectal carcinoma (CRC) surgery is still associated with significant infectious morbidity despite advances in recent decades in surgical techniques and antiseptic measures.With 1.8 million people diagnosed with CRC in 2018, this clinical problem remains a serious issue in surgical healthcare [1]. The vast majority of SSIs are caused by endogenous bacteria residing in the digestive tract, of which potentially pathogenic microorganisms (PPMs) account for most hospitalacquired infections [6,7]. These microorganisms are part of the gut microbiota’s composition, which is highly variable between different individuals. Surgical-site infection (SSI) and anastomotic leakage (AL) are major complications following surgical resection of colorectal carcinoma (CRC). Methods: A systematic review and meta-analysis of recent RCTs and cohort studies was performed including patients undergoing elective CRC surgery, receiving OABs with or without mechanical bowel preparation (MBP). A subgroup analysis demonstrated that SDD resulted in a significant reduction in AL rates compared to broad-spectrum

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