McChesney Shannon L, Zelhart Matthew D, Green Rebecca L, Nichols Ronald L
Department of Surgery, Tulane University, New Orleans, Louisiana.
Tulane University School of Medicine, New Orleans, Louisiana.
Surg Infect (Larchmt). 2020 Feb;21(1):1-8. doi: 10.1089/sur.2019.125. Epub 2019 Jul 30.
The effect of an oral antibiotic preparation prior to colorectal surgery was first examined and exalted in the 1973 paper by Nichols et al. Since this commencement, enthusiasm for the oral antibiotic regimen has waxed and waned reflecting the literature focused on this topic over the past 40 years. Polling colorectal surgeons of define current practices has been performed at intervals throughout the years and has demonstrated a trend to decline in the practice. The most recent publication surveying U.S. practices was in 2010, which reported a minority, 36%, use of oral antibiotics prior to elective colorectal surgery; a marked downtrend from the 88% use described in 1990. Since this last survey, the colorectal surgery community has performed considerable research examining the benefit of oral antibiotic and mechanical bowel preparation. This manuscript evaluates the current use of oral antibiotics in colorectal surgery in the U.S. and how practice trends have developed in response to current recommendations in the literature. An electronic survey was created and distributed to U.S. colorectal surgeons to evaluate current opinions and practice trends. A total of 359 American Society of Colon and Rectal Surgeons members responded. A review of the recent literature pertaining to pre-operative bowel practices and outcomes was performed to compare with current practices. A significant majority (83.2%) of respondents use pre-operative oral antibiotics routinely, and 98.6% routinely use mechanical bowel preparation. The use of a combination of parenteral antibiotics, oral antibiotics, and mechanical bowel preparation is reported by 79.3%. The most commonly employed oral antibiotic regimen is neomycin and metronidazole. The most common mechanical bowel preparation is polyethylene glycol (PEG). The most common parenteral antibiotics are cefazolin and metronidazole. There was no statistically significant difference in this practice by geographic region, Board-certified status, or practice setting. The majority of colorectal surgeons employ a combination of oral antibiotics, mechanical bowel preparation, and parenteral antibiotics prior to colorectal surgery. This is consistent across geographic regions, despite Board certification status or practice setting, and is reflective of the recommendations based on recent literature.
1973年Nichols等人发表的论文首次研究并赞扬了口服抗生素制剂在结直肠手术前的效果。自那时起，鉴于过去40年里围绕该主题的文献情况，对于口服抗生素方案的热情起起伏伏。多年来，人们不时对结直肠外科医生进行调查以确定当前的做法，结果显示采用该做法的趋势呈下降态势。最近一次针对美国相关做法的调查发表于2010年，该调查报道称，在择期结直肠手术前使用口服抗生素的医生占少数，为36%；与1990年所描述的88%的使用率相比，呈显著下降趋势。自上次调查以来，结直肠外科领域开展了大量研究，探讨口服抗生素和机械性肠道准备的益处。本手稿评估了美国结直肠手术中口服抗生素的当前使用情况，以及实践趋势是如何根据文献中的当前建议发展而来的。为此创建了一项电子调查并分发给美国结直肠外科医生，以评估他们当前的观点和实践趋势。共有359名美国结肠和直肠外科医师协会成员做出了回应。对近期有关术前肠道准备措施及结果的文献进行了回顾，以便与当前的做法进行比较。绝大多数（83.2%）受访者常规使用术前口服抗生素，98.6%的受访者常规使用机械性肠道准备。79.3%的受访者报告使用了静脉抗生素、口服抗生素和机械性肠道准备相结合的方法。最常用的口服抗生素方案是新霉素和甲硝唑。最常用的机械性肠道准备是聚乙二醇（PEG）。最常用的静脉抗生素是头孢唑林和甲硝唑。在地理区域（译者注：这里应该是指不同地区）、是否拥有委员会认证以及执业环境方面，这种做法没有统计学上的显著差异。大多数结直肠外科医生在结直肠手术前采用口服抗生素、机械性肠道准备和静脉抗生素相结合的方法。无论地理区域、是否拥有委员会认证或执业环境如何，情况都是如此，这反映了基于近期文献的建议。
