Department of Surgery SL-22, Tulane University, 1430 Tulane Ave, New Orleans, LA 70112, USA.
Tech Coloproctol. 2011 Dec;15(4):385-95. doi: 10.1007/s10151-011-0714-4. Epub 2011 Jul 23.
Oral non-absorbable antibiotics work by decreasing intraluminal bacterial content after mechanical bowel preparation. The advantage of adding oral non-absorbable antibiotics to intravenous antibiotics to decrease surgical site infection (SSI) after colorectal surgery is not well known. We conducted a meta-analysis of randomized controlled trials (RCT) comparing the effectiveness of combined oral non-absorbable and intravenous antibiotics versus intravenous antibiotics alone in reducing the incidence of SSI following colorectal surgery.
We included RCT comparing a combination of oral non-absorbable antibiotics and intravenous antibiotics to intravenous antibiotics alone in order to prevent SSI after colorectal surgery. Outcomes assessed included postoperative infectious complications, such as surgical wound infections (SWI) defined as a combination of superficial and deep SSI, organ-space infections and anastomotic dehiscence.
Sixteen RCT published between 1979 and 2007 were included in the meta-analysis. The overall analyses indicated that patients randomly assigned to an oral non-absorbable antibiotic in addition to an intravenous antibiotic had a reduced risk of SWI (RR: 0.57 [95% CI: 0.43-0.76], p = 0.0002) compared with participants receiving only intravenous antibiotics. The use of oral non-absorbable antibiotics in addition to intravenous antibiotics had no significant effect on organ-space infections (RR: 0.71 [95% CI: 0.43-1.16], p = 0.2) or the risk of anastomotic leak (RR: 0.63 [95% CI: 0.28-1.41], p = 0.3).
Our meta-analysis shows that a combination of oral non-absorbable antibiotics and intravenous antibiotics significantly lowers the incidence of SWI compared with intravenous antibiotics alone. In light of our results, the use of oral non-absorbable antibiotics in colorectal surgery should be encouraged.
口服非吸收性抗生素通过机械肠道准备后减少腔内细菌含量起作用。将口服非吸收性抗生素与静脉用抗生素联合用于降低结直肠手术后手术部位感染（SSI）的优势尚不清楚。我们对比较口服非吸收性和静脉用抗生素联合与单独静脉用抗生素在降低结直肠手术后 SSI 发生率的随机对照试验（RCT）进行了荟萃分析。
我们纳入了比较口服非吸收性抗生素联合静脉用抗生素与单独静脉用抗生素用于预防结直肠手术后 SSI 的 RCT。评估的结局包括术后感染性并发症，如手术切口感染（SWI）定义为浅部和深部 SSI、器官间隙感染和吻合口裂开的组合。
纳入了 1979 年至 2007 年发表的 16 项 RCT 进行荟萃分析。总体分析表明，与仅接受静脉用抗生素的参与者相比，随机分配接受口服非吸收性抗生素加静脉用抗生素的患者 SWI 风险降低（RR：0.57[95%CI：0.43-0.76]，p=0.0002）。与单独使用静脉用抗生素相比，联合使用口服非吸收性抗生素对器官间隙感染（RR：0.71[95%CI：0.43-1.16]，p=0.17）或吻合口漏的风险（RR：0.63[95%CI：0.28-1.41]，p=0.3）无显著影响。
我们的荟萃分析表明，与单独使用静脉用抗生素相比，口服非吸收性抗生素联合静脉用抗生素可显著降低 SWI 的发生率。鉴于我们的结果，在结直肠手术中应鼓励使用口服非吸收性抗生素。
