The influence of antibiotics on infection and anastomotic recurrence after colon resection for cancer.

Abstract

AbstractTwo hundred‐thirty bowel resections for cancer, performed during the 3‐year period 1975–1977, were reviewed with respect to the influence of antibiotic prophylaxis on wound infection rates and anastomotic recurrences. A large number of surgeons were involved, offering a variety of approaches and skills.The overall infection rate after surgery was a disappointing 16.8%. Sixty‐seven patients had no antibiotic prophylaxis of any kind, and the infection incidence in this group was 32.8%. In contrast, there was a 9.8% infection rate in the 163 patients who had received antibiotic prophylaxis in one form or another, a highly significant difference. Systemic perioperative therapy reduced the incidence of infection to 6.9%, and a combination of preoperative oral antibiotic therapy with perioperative systemic treatment resulted in a further reduction to 3.1%. There were no untoward consequences of short‐term oral antimicrobial therapy in terms of postoperative enterocolitis.Anastomotic recurrences were noted in 4 patients only, an incidence of 1.7%, all following anterior resection. Because of the small number, no correlations could be drawn between this form of recurrence and the use of oral intestinal antibiotics.It is concluded that both short‐term oral antibiotic bowel preparation and the systemic perioperative use of antimicrobial agents are effective in the control of infection after bowel surgery and carry little risk of “superinfection.” The combination of these 2 regimens appears to offer the highest degree of protection. The use of antibiotics should not be curtailed because of the theoretical risk of encouraging anastomotic recurrences.