Perioperative Antibiotic Selection and Surgical Site Infection in Elective Colon Surgery

Area of Science:

• Infectious Diseases
• Surgical Infections
• Pharmacology

Background:

• Colorectal surgery has high surgical site infection (SSI) rates, up to 30%.
• Previous research indicated cefazolin/metronidazole reduced SSIs compared to cefoxitin.
• Antibiotic prophylaxis choice is critical in preventing SSIs.

Purpose of the Study:

• To evaluate the association between prophylactic antibiotic choice and SSI rates in elective colon surgery.
• To compare the efficacy of ceftriaxone/metronidazole, cefoxitin, and ertapenem in preventing SSIs.
• To determine if ceftriaxone/metronidazole is superior to other agents for SSI prophylaxis.

Main Methods:

• Retrospective review of 241 elective colon surgery cases (2016-2018).
• Patients received prophylactic intravenous antibiotics: ceftriaxone/metronidazole, cefoxitin, or ertapenem.
• Exclusion of emergent cases; focus on elective procedures.

Main Results:

• A total of 21 SSIs were observed in 241 cases.
• Ceftriaxone/metronidazole group had a 4.5% SSI rate versus 12.2% for cefoxitin/ertapenem combined (P = .035).
• Ceftriaxone/metronidazole showed a statistically significant decrease in SSI compared to ertapenem (4.5% vs 14%, P = .03).

Conclusions:

• Ceftriaxone/metronidazole prophylaxis is associated with lower SSI rates in elective colon surgery.
• This regimen demonstrated superiority over ertapenem and a trend over cefoxitin.
• Recommendation for ceftriaxone/metronidazole as the preferred prophylactic antibiotic.