Academic Unit of Surgery, Glasgow Royal Infirmary Glasgow UK.
BJS Open. 2019 Oct 16;3(6):830-839. doi: 10.1002/bjs5.50224. eCollection 2019 Dec.
Preoperative oral antibiotics in addition to intravenous antibiotics and mechanical bowel preparation (MBP) may influence the gut microbiome and reduce both the postoperative systemic inflammatory response to surgery and postoperative infective complications following colorectal resection. This propensity score-matched study compared outcomes of patients undergoing left-sided colonic or rectal resection with or without a combination of oral antibiotics and MBP.
The addition of oral antibiotics and MBP to prophylactic intravenous antibiotics in left-sided colonic and rectal resections was introduced in 2015-2016 at a single institution. Propensity score matching was undertaken to compare the effects of oral antibiotics plus MBP neither oral antibiotics nor MBP on the postoperative systemic inflammatory response and short-term outcomes in patients undergoing left-sided colonic or rectal resection between 2013 and 2018.
Of 396 patients who had propensity score matching for host, anaesthetic and operative factors, 204 matched patients were identified. The addition of oral antibiotics and MBP was associated with a significantly reduced postoperative inflammatory response (reduced postoperative Glasgow Prognostic Score) on day 3 (odds ratio (OR) 0·66, 95 per cent c.i. 0·44 to 0·99; = 0·013) and day 4 (OR 0·46, 0·30 to 0·71; = 0·001). Significantly reduced overall complications (OR 0·31, 0·17 to 0·56; < 0·001), infective complications (OR 0·41, 0·22 to 0·77; = 0·011), surgical-site infection (OR 0·37, 0·17 to 0·83; = 0·024) and postoperative length of hospital stay (median 7 days 8 days in patients who had intravenous antibiotics alone; = 0·050) were also observed.
Preoperative oral antibiotics and MBP in addition to prophylactic intravenous antibiotics were associated with a reduction in the postoperative systemic inflammatory response and postoperative complications in patients undergoing resectional left-sided colonic or rectal surgery.
术前口服抗生素联合静脉抗生素和机械肠道准备(MBP)可能会影响肠道微生物群,减少结直肠切除术后的全身炎症反应和术后感染性并发症。本倾向评分匹配研究比较了接受左半结肠或直肠切除术的患者使用或不使用口服抗生素和 MBP 的治疗效果。
在单一中心,于 2015-2016 年开始在左半结肠和直肠切除术中联合应用口服抗生素和 MBP 以预防静脉抗生素。在 2013 年至 2018 年期间,采用倾向评分匹配比较接受左半结肠或直肠切除术的患者中,口服抗生素联合 MBP 与既不使用口服抗生素也不使用 MBP 对术后全身炎症反应和短期结局的影响。
在 396 例接受宿主、麻醉和手术因素倾向评分匹配的患者中,有 204 例匹配患者。与静脉抗生素相比,口服抗生素联合 MBP 可显著降低术后第 3 天(优势比(OR)0.66,95%置信区间(CI)0.44 至 0.99; = 0.013)和第 4 天(OR 0.46,0.30 至 0.71; = 0.001)的术后炎症反应(降低格拉斯哥预后评分)。总体并发症(OR 0.31,0.17 至 0.56; < 0.001)、感染性并发症(OR 0.41,0.22 至 0.77; = 0.011)、手术部位感染(OR 0.37,0.17 至 0.83; = 0.024)和术后住院时间(中位数 7 天 8 天,仅静脉抗生素患者; = 0.050)也显著降低。
在预防性静脉抗生素基础上,术前联合应用口服抗生素和 MBP 可降低行左半结肠或直肠切除术患者的术后全身炎症反应和术后并发症。