Aziz Madiha, Beale Jack, Sheehan Brynn, Bandy Nicholas, Martyak Michael
General Surgery, Eastern Virginia Medical School, Norfolk, VA, USA.
EVMS-Sentara Healthcare Analytics and Delivery Science Institute (HADSI), Norfolk, VA, USA.
Am Surg. 2020 Sep;86(9):1091-1093. doi: 10.1177/0003134820943567. Epub 2020 Aug 17.
The highest rates of surgical site infections (SSIs) are associated with colorectal operations (up to 30%). A sentinel paper showed that the use of intravenous (IV) cefazolin and metronidazole was associated with decreased rates of SSI compared with cefoxitin (6% vs 13%). We reviewed the association of SSI with prophylactic antibiotic choice. We specifically investigated the regimens of ceftriaxone and metronidazole IV, cefoxitin IV, or ertapenem.
We conducted a retrospective review of 532 colon surgeries between 2016 and 2018. Inclusion criteria were patients 18-89 years of age undergoing elective colon surgery who received ceftriaxone/metronidazole, cefoxitin, or ertapenem for prophylaxis. All emergent cases were excluded. This resulted in 241 elective colon cases for review. The primary endpoint was to determine if the use of ceftriaxone/metronidazole decreased the rate of SSI.
In total, there were 241 elective colon cases with 21 SSI. We compared SSI rates in the ceftriaxone/metronidazole group to those patients receiving either cefoxitin or ertapenem (4.5% vs 12.2%; = .035). We then compared SSI in ceftriaxone/metronidazole to SSI in cefoxitin (4.5% vs 10%; = .13). Finally, we compared SSI in the ceftriaxone/metronidazole group to SSI in the ertapenem group (4.5% vs 14%; = .03). Comorbidities and underlying factors were similar across all antibiotic groups.
In our experience, the use of ceftriaxone/metronidazole is associated with a decreased SSI rate. Furthermore, ceftriaxone/metronidazole use is superior to the use of ertapenem, with a trend toward superiority over cefoxitin. Based on this study, we recommend ceftriaxone/metronidazole as antibiotic prophylaxis for elective colon surgery.
手术部位感染（SSI）发生率最高与结直肠手术相关（高达30%）。一篇标志性论文表明，与头孢西丁相比，静脉注射（IV）头孢唑林和甲硝唑可降低SSI发生率（6%对13%）。我们回顾了SSI与预防性抗生素选择之间的关联。我们特别研究了头孢曲松和甲硝唑静脉注射、头孢西丁静脉注射或厄他培南的方案。
我们对2016年至2018年间的532例结肠手术进行了回顾性研究。纳入标准为年龄在18 - 89岁之间接受择期结肠手术且接受头孢曲松/甲硝唑、头孢西丁或厄他培南预防性治疗的患者。所有急诊病例均被排除。这导致241例择期结肠病例可供审查。主要终点是确定使用头孢曲松/甲硝唑是否能降低SSI发生率。
总共241例择期结肠病例中有21例发生SSI。我们将头孢曲松/甲硝唑组的SSI发生率与接受头孢西丁或厄他培南的患者进行比较（4.5%对12.2%；P = 0.035）。然后我们将头孢曲松/甲硝唑组的SSI发生率与头孢西丁组进行比较（4.5%对10%；P = 0.13）。最后，我们将头孢曲松/甲硝唑组的SSI发生率与厄他培南组进行比较（4.5%对14%；P = 0.03）。所有抗生素组的合并症和潜在因素相似。
根据我们的经验，使用头孢曲松/甲硝唑与降低SSI发生率相关。此外，使用头孢曲松/甲硝唑优于使用厄他培南，且有优于头孢西丁的趋势。基于本研究，我们推荐头孢曲松/甲硝唑作为择期结肠手术的抗生素预防性用药。
