Division of Colorectal Surgery, Herbert Irving Pavilion, New York-Presbyterian Hospital/Columbia University Medical Center, 161 Fort Washington Avenue, Floor 8, New York, NY, 10032, USA.
J Gastrointest Surg. 2018 Nov;22(11):1968-1975. doi: 10.1007/s11605-018-3837-3. Epub 2018 Jul 2.
BACKGROUND/PURPOSE: While the use of oral antibiotic (OA) for bowel preparation is gaining popularity, it is unknown whether it increases the risk of Clostridium difficile infection (CDI). This study aimed to evaluate the impact of OA on the development of CDI after colectomy.
Patients who underwent colectomy from the ACS-NSQIP data (2015 and 2016) were included. Patients who received OA as bowel preparation were compared to those who did not with respect to demographics, comorbidities, primary diagnosis, procedure type and approach, and 30-day postoperative complications. Multivariable analysis was performed to characterize the association between OA and CD infection after colectomy. A sub-group analysis was also conducted for patients who did not develop any postoperative infectious complication.
Of 36,374 included patients, 18,177 (50%) received OA and 527 (1.4%) developed CDI for the whole cohort. OA group had more younger, functionally independent and obese patients with lower American Society of Anesthesiologists and wound class. Smoking, diabetes, hypertension, dyspnea or ventilator-dependence, congestive heart failure, disseminated cancer, bleeding disorder, and perioperative transfusion were significantly higher for non-OA group. Mechanical bowel preparation, minimally invasive surgery, conversion to open and operative duration ≥ 180 min were more prevalent in the OA group. The OA group had significantly reduced occurrence of CDI; superficial, deep, and organ space infections; wound disruption; anastomotic leak; reoperation; and infections including sepsis, septic shock, pneumonia, and urinary tract infection. On multivariable analysis, OA reduced the odds for CDI after colectomy (OR = 0.6, 95% CI = [0.5-0.8]). For patients who did not develop infectious postoperative complications, OA was associated with lower risk of CDI (OR = 0.7, CI = [0.5-0.9]). While complications, reoperation, and readmission rates were the same, postoperative ileus and hospital stay were significantly lower for those who developed CDI after receiving OA when compared to non-OA.
The use of OA as bowel preparation may reduce, rather than increase, the risk of 30-day CDI after colectomy. This effect may partly be due to the other recovery advantages associated with oral antibiotics. These data further support current data recommending the use of oral antibiotics for bowel preparation before colectomy.
背景/目的：虽然口服抗生素（OA）用于肠道准备越来越受欢迎，但尚不清楚它是否会增加艰难梭菌感染（CDI）的风险。本研究旨在评估 OA 对结直肠切除术后 CDI 发展的影响。
纳入了 ACS-NSQIP 数据（2015 年和 2016 年）中接受结直肠切除术的患者。比较接受 OA 作为肠道准备的患者与未接受 OA 的患者在人口统计学、合并症、主要诊断、手术类型和方法以及 30 天术后并发症方面的差异。采用多变量分析来描述 OA 与结直肠切除术后 CD 感染之间的关系。还对未发生任何术后感染性并发症的患者进行了亚组分析。
在 36374 例纳入患者中，18177 例（50%）接受了 OA，527 例（1.4%）出现了 CDI。OA 组患者更年轻、功能独立、肥胖，美国麻醉医师协会和伤口分级较低。非 OA 组患者中，吸烟者、糖尿病、高血压、呼吸困难或呼吸机依赖、充血性心力衰竭、播散性癌症、出血性疾病和围手术期输血的比例显著更高。机械肠道准备、微创手术、转为开放手术和手术时间≥180 分钟在 OA 组更为常见。OA 组的 CDI、浅表感染、深部感染和器官间隙感染、伤口裂开、吻合口漏、再次手术以及包括脓毒症、感染性休克、肺炎和尿路感染在内的感染发生率显著降低。多变量分析显示，OA 降低了结直肠切除术后 CDI 的发生几率（OR=0.6，95%CI[0.5-0.8]）。对于未发生术后感染性并发症的患者，OA 与 CDI 风险降低相关（OR=0.7，95%CI[0.5-0.9]）。尽管并发症、再次手术和再入院率相同，但与未接受 OA 的患者相比，接受 OA 的患者术后肠梗阻和住院时间显著降低。
OA 用于肠道准备可能会降低结直肠切除术后 30 天 CDI 的风险，而不是增加其风险。这种效果可能部分归因于口服抗生素相关的其他恢复优势。这些数据进一步支持目前推荐在结直肠切除术前使用口服抗生素进行肠道准备的数据。
