title: Preoperative oral antibiotics in colorectal surgery increase the rate of Clostridium difficile colitis.
abstract: OBJECTIVE
  Bowel preparation traditionally consists of cathartics, oral antibiotics, and intravenous antibiotics. We hypothesize that the use of oral antibiotics in bowel preparation results in a higher rate of postoperative Clostridium difficile colitis.
  
  
  METHODS
  Retrospective case-controlled study of elective colon surgery patients; January 1997 to June 2003.
  
  
  METHODS
  Tertiary care veterans administration hospital.
  
  
  METHODS
  Records of patients who underwent elective colorectal surgery (n = 304) were reviewed. Patients with bowel obstruction or emergent operation were excluded.
  
  
  METHODS
  Detection of C difficile toxin A/B by enzyme-linked immunosorbent assay in a stool specimen within 30 days of surgery.
  
  
  RESULTS
  All 304 patients received both cathartics and intravenous antibiotics. Of 304 patients, 107 (35.1%) received oral antibiotics. The rate of postoperative C difficile colitis was 4.2% in the entire study population. The rate of C difficile infection was higher in patients who received oral antibiotics (7.4%) compared with patients who did not receive oral antibiotics (2.6%; P = .03). There were no C difficile-related mortalities.
  
  
  CONCLUSIONS
  Oral nonabsorbable antibiotics in bowel preparation resulted in a higher rate of C difficile infection. This may be due to the additional effect of oral antibiotics on normal bowel flora. We recommend that oral nonabsorbable antibiotics not be used in preoperative bowel preparation regimens since postoperative C difficile infection can lead to additional morbidity, length of stay, and hospital costs.
authors.affiliation: Palo Alto Veterans Health Care System and Department of Surgery, Stanford University School of Medicine, 3801 Miranda Avenue, Palo Alto, CA 94304, USA. swren@stanford.edu
authors.forename: Sherry M
authors.initials: SM
authors.lastname: Wren
authors.forename: Natasha
authors.initials: N
authors.lastname: Ahmed
authors.forename: Ayesha
authors.initials: A
authors.lastname: Jamal
authors.forename: Bassem Y
authors.initials: BY
authors.lastname: Safadi
mesh_terms: D000284:Administration, Oral; D019072:Antibiotic Prophylaxis / Q000009:adverse effects*; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000302:isolation & purification*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D003107:Colorectal Surgery / Q000009:adverse effects / Q000379:methods*; D016001:Confidence Intervals; D004359:Drug Therapy, Combination / Q000009:adverse effects* / Q000627:therapeutic use; D004761:Enterocolitis, Pseudomembranous / Q000139:chemically induced* / Q000453:epidemiology; D004917:Erythromycin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009355:Neomycin / Q000009:adverse effects / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment
chemical_list: D004917:Erythromycin; D009355:Neomycin