Prophylactic antimicrobials in elective colorectal and biliary surgery

In 97 patients undergoing elective biliary (44) or colorectal (53) surgery, cases were randomly allocated to receive peri-operative prophylaxis with either cefoxitin (Mefoxin; MSD) or metronidazole, penicillin and tobramycin (MPT). Sepsis occurred in 3 of the biliary cases (6,8%) and in 16 of the colorectal cases (30,2%). In the colorectal group sepsis occurred equally in patients receiving cefoxitin (22,2%) or MPT (38,5%) (P = 0,20). Patients who developed sepsis did not have a prolonged hospital stay; strict criteria were used to define sepsis in this study and this explains the apparently high sepsis rate. A positive wound culture at the end of the operation was more common after colorectal surgery (30,2%) than after biliary surgery (4,6%) and was associated with a higher subsequent infection rate (P = 0,02).