Ghuman A, Kasteel N, Brown C J, Karimuddin A A, Raval M J, Wexner S D, Phang P T
Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.
Colorectal Dis. 2020 Nov;22(11):1686-1693. doi: 10.1111/codi.15153. Epub 2020 Jun 14.
Surgical site infections are disproportionately common after colorectal surgery and may be largely preventable. The objective of this retrospective cohort study was to determine the effect of oral antibiotics and mechanical bowel preparation on surgical site infections.
A retrospective study of a consecutive series of elective colonic and rectal resections following an Enhanced Recovery After Surgery pathway, which also included mechanical bowel preparation, from 1 September 2014 to 30 September 2017. The addition of oral antibiotics (neomycin and metronidazole) to the mechanical bowel preparation procedure was assessed. Development of surgical site infections within 30 days was the main outcome measured. The secondary outcome was assessment of possible surgical site infection predictors.
Seven-hundred thirty-two patients were included: 313 (43%) preintervention (mechanical bowel preparation only); and 419 (57%) postintervention (mechanical bowel preparation plus oral antibiotics). Surgical site infection rates preintervention and. postintervention were: overall, 20.8% vs 10.5%, P < 0.001; superficial, 10.9% vs 4.3%, P < 0.001; and organ space, 9.9% vs 6.2%, P = 0.03. Subgroup analysis of colonic resections revealed a significant reduction in overall (17.1% vs 6.8%), superficial (10.7% vs 4.3%) and organ space (6.4% vs. 2.6%) infections. Rectal resections had significant reduction in overall (26.2% vs 15.3%) and superficial (11.1% vs 4.4%) infection rates but not in organ space infections (15.1% vs 10.9%). Multivariate regression analysis revealed open vs minimally invasive surgery (P < 0.001) and omission of oral antibiotics (P = 0.004) as independent predictors of surgical site infections.
Administration of oral antibiotics resulted in significant reduction of superficial and organ space infections after colonic resection; after rectal resection, significant reduction only of superficial infections was found.
结直肠手术后手术部位感染极为常见，且很大程度上是可预防的。这项回顾性队列研究的目的是确定口服抗生素和机械肠道准备对手术部位感染的影响。
对2014年9月1日至2017年9月30日期间按照术后加速康复路径进行的一系列连续择期结肠和直肠切除术进行回顾性研究，该路径也包括机械肠道准备。评估了在机械肠道准备过程中添加口服抗生素（新霉素和甲硝唑）的情况。主要测量指标是30天内手术部位感染的发生情况。次要指标是评估可能的手术部位感染预测因素。
共纳入732例患者：干预前313例（仅进行机械肠道准备）；干预后419例（机械肠道准备加口服抗生素）。干预前和干预后的手术部位感染率分别为：总体，20.8%对10.5%，P<0.001；浅表感染，10.9%对4.3%，P<0.001；器官间隙感染，9.9%对6.2%，P=0.03。结肠切除术的亚组分析显示总体感染（17.1%对6.8%）、浅表感染（10.7%对4.3%）和器官间隙感染（6.4%对2.6%）显著减少。直肠切除术的总体感染率（26.2%对15.3%）和浅表感染率（11.1%对4.4%）显著降低，但器官间隙感染率未降低（15.1%对10.9%）。多因素回归分析显示，开放手术与微创手术（P<0.001）以及未使用口服抗生素（P=0.004）是手术部位感染的独立预测因素。
口服抗生素给药使结肠切除术后浅表和器官间隙感染显著减少；直肠切除术后，仅浅表感染显著减少。
