Peroperative systemic prophylaxis in colorectal surgery

Area of Science:

• Surgical Infectious Diseases
• Clinical Microbiology
• Colorectal Surgery

Background:

• High infection rates in elective colorectal surgery necessitate effective antimicrobial prophylaxis.
• Traditional methods often involve oral non-absorbable antimicrobials, which can have drawbacks.
• Exploring short-course systemic antimicrobial regimens is crucial for optimizing patient outcomes.

Purpose of the Study:

• To evaluate the efficacy of a short course of systemic antimicrobials in reducing surgical site infections (SSIs) in elective colorectal surgery.
• To assess the effectiveness of metronidazole combined with either netilmicin or cefuroxime, compared to placebo, for SSI prevention.
• To determine if acceptable infection rates can be achieved without oral non-absorbable antimicrobials.

Main Methods:

• A multicentre, double-blind trial involving 50 patients undergoing elective colorectal surgery.
• Patients received metronidazole for anti-anaerobic coverage.
• Anti-aerobic coverage included either netilmicin, cefuroxime, or a placebo, administered systemically.

Main Results:

• Out of 36 evaluable patients, five developed infections at the operation site.
• Two cases of peritonitis occurred (one in the metronidazole-netilmicin group, one in the metronidazole-placebo group).
• Three cases of wound abscess were observed, all in the metronidazole-placebo group.

Conclusions:

• A short course of peroperative systemic prophylaxis using metronidazole plus netilmicin or cefuroxime yielded acceptable infection rates.
• This regimen proved effective in reducing SSIs without the need for oral non-absorbable antimicrobials.
• The findings support the use of this systemic approach in elective colorectal surgery centers.