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Reduced antibiotic dosing, duration, effective for preventing infection in colorectal surgery
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Patients undergoing colorectal surgery showed the same rate of surgical site infection whether they were given antibiotics for 24 hours after surgery or only one dose of antibiotic before surgery with redosing during long operations, according to new research.
“Preoperative antibiotic dosing with intraoperative re-dosing is an opportunity for surgeons to maximize quality while minimizing [surgical site infection (SSI)] and unnecessary antibiotic risk,” David W. Larson, MD, MBA, of the division of colon and rectal surgery at the Mayo Clinic in Rochester, Minn., said in a press release.
While the timing, selection and dosing of antibiotics for SSI prevention have been studied, data on optimal duration are lacking, and overuse continues to be the norm in the U.S., Larson and colleagues wrote. Therefore, they reviewed outcomes data on 965 patients who underwent laparoscopic or traditional colorectal surgery, and compared the rate of superficial and deep surgical site infections before and after Mayo Clinic changed antibiotic prophylaxis for colorectal surgery patients to eliminate postoperative antibiotic coverage in January 2014.
The first cohort (2012-2013; n = 493) received “24-hour dose duration coverage with preoperative dose duration with redosing intraoperatively after 3 hours of operating where appropriate for the medication and additional doses postoperatively,” Larson and colleagues wrote. The second cohort (2014-2015; n = 472) received care following “the same principles of antibiotic coverage from incision to closure, where pre- and intraoperative timing, dosing and redosing, and selection remained the same. This cohort, however, eliminated the postoperative dosing coverage.”
Both cohorts showed comparable SSI rates (5.7% vs. 5.3%), whether they were superficial SSIs (4.3% vs. 4%) or deep SSIs (1.4% vs. 1.3%). There was also no significant difference in SSI rates between laparoscopic and open surgery (4.2% vs. 6.5%).
“This study demonstrated no difference in superficial or deep SSI rates related to an antibiotic regimen change, eliminating the traditional postoperative dosing coverage in colorectal surgery,” Larson and colleagues concluded. “These results present an opportunity for others to reconsider their own institutions’ standards of practice to optimize a SSI, and minimize unnecessary antibiotics.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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