Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University of Munich, Marchioninistr. 15, D-81377, Munich, Germany.
Department of General, Visceral, Vascular and Endocrine Surgery, Agatharied Hospital, Hausham, Germany.
Int J Colorectal Dis. 2021 Aug;36(8):1667-1676. doi: 10.1007/s00384-021-03890-1. Epub 2021 Feb 19.
There is an ongoing debate on whether or not to use oral antibiotic bowel decontamination in colorectal surgery, despite the numerous different regimens in terms of antibiotic substances and duration of application. As we routinely use oral antibiotic bowel decontamination (selective decontamination of the digestive tract (SDD) regimen and SDD regimen plus vancomycin since 2016) in surgery for diverticular disease, our aim was to retrospectively analyze the perioperative outcome in two independent centers.
Data from two centers with a routine use of oral antibiotic bowel decontamination for up to 20 years of experience were analyzed for the perioperative outcome of 384 patients undergoing surgery for diverticular disease.
Overall morbidity was 12.8%, overall mortality was 0.3%, the overall rate of anastomotic leakage (AL) was 1.0%, and surgical site infections (SSIs) were 5.5% and 7.8% of all infectious complications including urinary tract infections and pneumonia. No serious adverse events were related to use of oral antibiotic bowel decontamination. Most of the patients (93.8%) completed the perioperative regimen. Additional use of vancomycin to the SDD regimen did not show a further reduction of infectious complications, including SSI and AL.
Oral antibiotic decontamination appears to be safe and effective with low rates of AL and infectious complications in surgery for diverticular disease.
尽管抗生素药物种类和应用持续时间存在诸多差异，但在结直肠手术中是否使用口服抗生素肠道去污仍存在争议。由于我们在憩室病手术中常规使用口服抗生素肠道去污（选择性肠道去污（SDD）方案和自 2016 年以来的 SDD 方案加万古霉素），我们旨在回顾性分析两个独立中心的围手术期结果。
对两个中心的数据进行分析，这些中心常规使用口服抗生素肠道去污达 20 年以上，共分析了 384 例接受憩室病手术的患者的围手术期结果。
总发病率为 12.8%，总死亡率为 0.3%，总的吻合口漏（AL）发生率为 1.0%，手术部位感染（SSI）发生率为 5.5%，所有感染性并发症（包括尿路感染和肺炎）的发生率为 7.8%。使用口服抗生素肠道去污未发生与严重不良事件相关的并发症。大多数患者（93.8%）完成了围手术期方案。在 SDD 方案中额外使用万古霉素并没有进一步降低感染性并发症的发生率，包括 SSI 和 AL。
口服抗生素去污在憩室病手术中似乎是安全有效的，吻合口漏和感染性并发症的发生率较低。
