Antibiotic Prophylaxis Strategies and Surgical Site Infections in Colorectal Surgery: A Systematic Review and Network...

Area of Science:

• Infectious Diseases
• Surgical Oncology
• Pharmacology

Background:

• Antibiotic prophylaxis is crucial for preventing surgical site infections (SSIs) in elective colorectal surgery.
• Optimal antibiotic class selection remains uncertain, with existing reviews focusing on administration timing and route.

Purpose of the Study:

• To conduct a network meta-analysis comparing outcomes of different antibiotic classes for prophylaxis in elective colorectal surgery.
• To evaluate the efficacy of various antibiotic regimens in reducing SSIs and other key surgical outcomes.

Main Methods:

• Systematic search of MEDLINE, Embase, Cochrane Central, and Scopus databases.
• Inclusion of 105 randomized clinical trials (18,273 patients) reporting on SSIs within 30 days.
• Network meta-analysis using a frequentist random-effects model to compare 32 distinct antibiotic regimens.

Main Results:

• Several antibiotic regimens significantly reduced SSI risk compared to placebo, including broad-spectrum penicillin, third-generation cephalosporins, metronidazole plus second-generation cephalosporins, and tetracyclines.
• Broad-spectrum penicillin and fluoroquinolone-penicillin combinations were associated with reduced 30-day mortality.
• No significant differences were found between antibiotic classes for length of hospital stay or adverse events; evidence certainty ranged from very low to moderate.

Conclusions:

• Multiple antibiotic regimens effectively reduce SSIs following elective colorectal surgery.
• Broad-spectrum penicillins demonstrated the most consistent benefits, with moderate-certainty evidence for reduced SSI and mortality risk.
• Findings support informed antibiotic selection for optimizing patient outcomes in colorectal surgery.