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Ecological impact of antimicrobial prophylaxis on intestinal microflora in patients undergoing colorectal surgery
B Brismar1, C Edlund, A S Malmborg
1Department of Surgery, Huddinge University Hospital, Sweden.
Abstract:
During recent years the impact of different antimicrobial agents on the intestinal microflora in patients undergoing colorectal surgery has been investigated by our research group. Thus the effects on the microflora by parenteral administration of piperacillin, cefoxitin, cefbuperazone, moxalactam, aztreonam, imipenem, ampicillin + sulbactam, clindamycin, tinidazole, ciprofloxacin and ofloxacin have been studied. Pronounced changes were observed in the aerobic microflora in patients receiving ciprofloxacin and ofloxacin, in the anaerobic microflora in patients receiving clindamycin and tinidazole and in both the aerobic and anaerobic microflora in those patients receiving piperacillin, cefoxitin, cefbuperazone, moxalactam, aztreonam, imipenem and ampicillin + sulbactam. Postoperative infections were observed in patients receiving piperacillin (2), ampicillin + sulbactam (1), cefoxitin (1), aztreonam (3), tinidazole (6), clindamycin (5) and ofloxacin (5). In the patient groups receiving cefbuperazone, moxalactam, imipenem and ciprofloxacin, no postoperative infections occurred.
Insights
Different antibiotics significantly alter gut microflora in colorectal surgery patients. Some agents, like cefbuperazone and imipenem, showed no associated postoperative infections, suggesting potential benefits.
Area of Science:
- Microbiology
- Pharmacology
- Surgical Infectious Diseases
Background:
- Intestinal microflora plays a crucial role in patient health, especially post-surgery.
- Antimicrobial agents are frequently used in colorectal surgery, potentially disrupting this delicate balance.
- Understanding the impact of various antibiotics on gut microbiota is essential for optimizing patient outcomes.
Purpose of the Study:
- To investigate the effects of parenteral antimicrobial agents on intestinal microflora in patients undergoing colorectal surgery.
- To correlate changes in aerobic and anaerobic microflora with the incidence of postoperative infections.
- To identify antimicrobial agents with a potentially lower risk of postoperative infections.
Main Methods:
- Parenteral administration of twelve different antimicrobial agents: piperacillin, cefoxitin, cefbuperazone, moxalactam, aztreonam, imipenem, ampicillin + sulbactam, clindamycin, tinidazole, ciprofloxacin, and ofloxacin.
- Monitoring of changes in both aerobic and anaerobic intestinal microflora.
- Recording and analysis of postoperative infection rates in relation to the administered antimicrobial agent.
Main Results:
- Significant alterations in aerobic microflora were observed with ciprofloxacin and ofloxacin.
- Significant alterations in anaerobic microflora were noted with clindamycin and tinidazole.
- Broad-spectrum changes affecting both aerobic and anaerobic microflora occurred with piperacillin, cefoxitin, cefbuperazone, moxalactam, aztreonam, imipenem, and ampicillin + sulbactam.
- Postoperative infections were reported in patients receiving piperacillin, ampicillin + sulbactam, cefoxitin, aztreonam, tinidazole, clindamycin, and ofloxacin.
- Notably, no postoperative infections occurred in patients treated with cefbuperazone, moxalactam, imipenem, or ciprofloxacin.
Conclusions:
- The choice of antimicrobial agent significantly impacts intestinal microflora composition in colorectal surgery patients.
- Certain antimicrobial agents, including cefbuperazone, moxalactam, imipenem, and ciprofloxacin, were associated with zero postoperative infections in this study.
- These findings suggest that some antibiotics may offer a favorable safety profile regarding postoperative infection risk in this patient population.