Preoperative oral antibiotics and intravenous antimicrobial prophylaxis reduce the incidence of surgical site infections in patients with ulcerative colitis undergoing IPAA.

BACKGROUND

The usefulness of preoperative oral antibiotics for the prevention of surgical site infection in elective colorectal surgery remains controversial.

OBJECTIVE

This study aimed to investigate the effects of oral antimicrobial prophylaxis in addition to intravenous antimicrobial prophylaxis on patients with ulcerative colitis undergoing restorative proctocolectomy.

DESIGN

This study was a randomized, nonblinded, single-center clinical trial.

SETTING

This study was conducted between July 1, 2006, and April 30, 2009, at Hyogo College of Medicine.

PATIENTS

Two hundred patients with ulcerative colitis scheduled to undergo restorative proctocolectomy with IPAA with an open approach were randomly assigned to either group A or B (n = 100). Combined use of preoperative oral antibiotics and intravenous antimicrobial prophylaxis were given to group A, and intravenous antimicrobial prophylaxis alone was given to group B.

INTERVENTIONS

Patients in group A received oral antibiotics the day before surgery (500 mg of kanamycin and 500 mg of metronidazole at 2:00 P.M., 3:00 P.M., and 9:00 P.M.), whereas those in group B did not. All patients underwent preoperative mechanical bowel preparation, and intravenous antimicrobial prophylaxis with second-generation cephalosporin was given for 24 hours.

MAIN OUTCOME MEASURES

The primary end point of this study was the incidence of overall surgical site infection according to intention-to-treat analysis.

RESULTS

The incidence of overall surgical site infection was significantly lower in group A (6/97 patients, 6.1%) than in group B (22/98 patients, 22.4%) (p = 0.0024). In multivariate analysis, the administration of oral antibiotics (OR, 0.178; 95% CI, 0.057-0.552; p = 0.003) and ASA score ≥3 (OR, 5.343; 95% CI, 1.595-17.891; p = 0.007) were independent risk factors for surgical site infection.

LIMITATIONS

This study is limited because of its open-label nature.

CONCLUSIONS

Combined oral and intravenous antimicrobial prophylaxis in patients with ulcerative colitis undergoing restorative proctocolectomy with IPAA contributed to the prevention of surgical site infection.