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Oral antibiotic preparation reduces SSI risk by 50% after colorectal surgery
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Results from a meta-analysis of observational studies found that oral antibiotic preparation by itself before colorectal surgery reduces the risk for surgical site infections, or SSIs, by 50% and is comparable to combining oral antibiotic preparation with mechanical bowel preparation.
Oral antibiotic preparation (OAP) and mechanical bowel preparation (MBP) have been used — usually together — to reduce the increased risk for SSIs experienced by patients undergoing colorectal surgery, according to Tessa Mulder, MD, a PhD candidate in epidemiology, and Jan A.J.W. Kluytmans, PhD, professor of epidemiology, both at the University Medical Center Utrecht, Netherlands.
However, MBP is no longer standard practice because of a lack of evidence that it benefits patients, and it is unclear whether OAP can be used alone, the researchers wrote.
For their review, Mulder and Kluytmans identified 15 studies with reported data on OAP without MBP, but OAP on its own was the least implemented preparation in almost all the studies. Moreover, they found that 13 studies used data from 2012 through 2015 from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, leading them to suspect “a substantial overlap in participants,” so only the largest study was included in their meta-analysis.
According to the findings, SSI risk was significantly reduced when patients received OAP only compared with no preparation (aOR = 0.51; 95% CI, 0.37–0.71). Similarly, compared with no preparation, SSI risk also was significantly reduced when patients received OAP combined with MBP (aOR = 0.42; 95% CI, 0.37–0.49). Results from the largest study showed no significant difference between MBP with OAP and OAP alone (adjusted OR = 0.78; 95% CI, 0.55–1.08), Mulder and Kluytmans reported.
They noted several limitations of the review, including the inclusion of only one of the studies performed on the ACS-NSQIP database.
“Nevertheless, all studies reported a protective effect of OAP; therefore, we considered the direction of the effect reliable. The magnitude of the effect, however, could not be directly determined because of the limitations that apply to the ACS-NSQIP database, which we believe affected all the studies performed on these data,” they wrote.
“Considering the absence of a beneficial effect of MBP alone, the only rationale for continuation of MBP in combination with OAP is because it was hypothesized that the antibiotics were not effective in an uncleansed colon. Based on our findings, we consider the added value of MBP to be questionable at best,” they concluded.
“High-quality evidence is needed to confirm the efficacy of OAP without MBP. [A randomized controlled trial] that includes an OAP-only arm and is powered to detect a 40% reduction in SSI risk may bring us closer to closing the research gap on the use of OAP and the necessity of MBP.” – by Marley Ghizzone
Disclosures: The authors report no relevant financial disclosures.
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