Comparison between systemic and oral antimicrobial prophylaxis in colorectal surgery

Area of Science:

• Surgical Infection Prevention
• Antimicrobial Prophylaxis
• Colorectal Surgery

Background:

• Postoperative sepsis remains a significant risk in colorectal surgery.
• The optimal route for antimicrobial prophylaxis is debated.
• Oral antimicrobial prophylaxis may lead to adverse outcomes.

Purpose of the Study:

• To compare the efficacy and safety of systemic versus oral antimicrobial prophylaxis in elective colorectal surgery.
• To evaluate the incidence of postoperative sepsis and associated complications with different prophylaxis routes.

Main Methods:

• Prospective randomized trial involving 93 patients undergoing elective colorectal operations.
• Patients received either oral or systemic prophylactic antimicrobials (metronidazole and kanamycin).
• Outcomes assessed included postoperative sepsis, bacterial resistance, superinfection, and antibiotic-associated pseudomembranous colitis.

Main Results:

• Systemic prophylaxis resulted in significantly lower sepsis rates (6.5%) compared to oral prophylaxis (36%) (P < 0.01).
• Oral prophylaxis was associated with kanamycin-resistant infections (15/17), Staphylococcus aureus overgrowth (6 patients), and antibiotic-associated pseudomembranous colitis (6/7 patients).
• Infections in the oral group were often due to pre-existing kanamycin-resistant colonic bacteria.

Conclusions:

• Oral administration of prophylactic antimicrobials in colon surgery should be avoided.
• Systemic per-operative antimicrobial prophylaxis is safer and more effective in preventing postoperative sepsis.
• Risks associated with oral prophylaxis include bacterial resistance, superinfection, and pseudomembranous colitis.