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Do Preoperative Oral Antibiotics Decrease the Incidence of Surgical Site Infection After Segmental Colectomy Without a Mechanical Bowel Prep?
Sarah J. Atkinson*, Bradley R. Davis, Janice F. Rafferty, Martha Ferguson, Ian M. Paquette
Colon and Rectal Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
Purpose: Preoperative oral antibiotics (Neomycin and Flagyl) have been shown to decrease the incidence of surgical site infection in colectomy patients who completed a preoperative mechanical bowel prep. Mechanical bowel prep has now been shown to be unnecessary, and potentially harmful for patients having a segmental colectomy. Our hypothesis is that preoperative oral antibiotics do not decrease the incidence of postoperative surgical site infection (SSI) in patients who did not receive a mechanical bowel prep prior to segmental colectomy.
Methods: We performed a retrospective review of 185 patients who underwent a segmental colectomy without mechanical bowel prep by a group of 4 colorectal surgeons at a single academic medical center from July 2011 - July 2013. A total of 66 patients received preoperative Neomycin and Flagyl in addition to perioperative IV antibiotics, while 119 received perioperative IV antibiotics alone. Oral antibiotics were given at the discretion of the attending surgeon. The primary outcome was postoperative surgical site infection. Multivariate logistic regression was performed to control for patient and surgical factors associated with surgical site infection.
Results: A total of 66 patients received preoperative Neomycin and Flagyl, while 119 patients did not. The two groups were equally matched, with two exceptions. There was a higher proportion of cases performed laparoscopically in the group that did not receive oral antibiotics (75.7% versus 49.6%, p= 0.001), and the diagnosis of diabetes was more prevalent in the group that did not receive oral antibiotics (21.2% versus 10.1%, p=0.0031). Postoperative surgical site infection occurred in 10.9% of patients who received Neomycin and Flagyl and 10.6% percent of those who did not (p=0.95). Multivariate analysis of surgical and patient factors indicated that estimated blood loss (OR = 3.76 95% CI = 1.24-11.36), and perioperative steroid use (OR = 7.7 95% CI = 1.34-44.8) were associated with postoperative SSI. When controlling for patient and surgical factors, preoperative Neomycin and Flagyl did not decrease the incidence of SSI (OR = 0.75, 95% CI = 0.026-2.19).
Conclusion: In the absence of mechanical bowel prep, preoperative oral antibiotics do not reduce the incidence of surgical site infection following segmental colectomy.
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