Department of Colorectal Surgery, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK.
Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
Int J Colorectal Dis. 2023 Aug 9;38(1):210. doi: 10.1007/s00384-023-04497-4.
Surgical site infections (SSIs) are common in colorectal surgery. Mechanical bowel preparation (MBP) in conjunction with oral antibiotics (OABs) have been shown to reduce SSI rates. It however is still unclear which OABs to use, and how this can be implemented in practice.
This is a prospective observational study carried out in Swansea Bay University Health Board during 2019-2021, evaluating the introduction of OABs in a stepwise manner on the incidence of SSI in major colorectal surgery. A control group having MBP only was compared to two OAB groups: one group had MBP plus metronidazole only and the second MBP plus metronidazole and neomycin. A 30-day follow-up after surgery was ascertained via chart review and telephone contact. Logistic regression was performed to estimate the relation between OAB use and SSI, with adjustment for confounding. In a subset of patients, faecal samples were analysed through 16S rRNA amplicon sequencing before and after OAB treatment, depicting the impact of the gut microbiome.
In total 160 patients were analysed: 46 patients had MBP only, whilst 76 patients had MBP plus metronidazole only and 38 patients had MBP with metronidazole/neomycin. The SSI rate in the entire cohort was 33.8%, whilst the adjusted ORs for the single- and dual-OAB groups were 0.76 (95% CI: 0.17-1.81) and 0.50 (95% CI: 0.17-1.52). The microbial analysis demonstrated that the relative abundance for many bacterial genera was changed before and after OAB treatment, but no link with SSI development could be shown.
Introduction of OABs in conjunction with MBP in colorectal surgery is feasible, and may potentially lead to lower rates of SSI, as well as altering the community structure of the faecal microbiome. More research is needed, especially considering different OABs and mechanistic studies of the gut microbiome in the context of colorectal surgery.
手术部位感染（SSI）在结直肠手术中很常见。已证实机械肠道准备（MBP）联合口服抗生素（OABs）可降低 SSI 发生率。然而，目前仍不清楚应使用哪种 OABs，以及如何在实践中实施。
这是一项在 2019 年至 2021 年期间在斯旺西湾大学健康委员会进行的前瞻性观察研究，评估了在结直肠大手术中逐步引入 OABs 对 SSI 发生率的影响。将接受 MBP 治疗的对照组与接受 MBP 联合甲硝唑的一组和 MBP 联合甲硝唑和新霉素的二组进行比较。通过病历回顾和电话联系，对术后 30 天进行随访。采用逻辑回归估计 OAB 使用与 SSI 之间的关系，并进行混杂因素调整。在部分患者中，在使用 OAB 前后通过 16S rRNA 扩增子测序分析粪便样本，描述肠道微生物组的影响。
共分析了 160 例患者：46 例仅接受 MBP 治疗，76 例仅接受 MBP 联合甲硝唑治疗，38 例接受 MBP 联合甲硝唑/新霉素治疗。整个队列的 SSI 发生率为 33.8%，单一组和双 OAB 组的调整比值比（OR）分别为 0.76（95%CI：0.17-1.81）和 0.50（95%CI：0.17-1.52）。微生物分析表明，在使用 OAB 前后，许多细菌属的相对丰度发生了变化，但未发现与 SSI 发展相关的变化。
在结直肠手术中联合 MBP 使用 OABs 是可行的，可能会降低 SSI 发生率，并改变粪便微生物组的群落结构。需要进一步研究，特别是考虑不同的 OABs 和结直肠手术中肠道微生物组的机制研究。
