Perioperative selective decontamination of the digestive tract (SDD) in elective colorectal surgery.
BACKGROUND
Selective decontamination of the digestive tract (SDD) decreases morbidity and mortality in critically ill patients and morbidity in patients undergoing esophageal resection. This study analyzes the effect of perioperative SDD in patients undergoing elective colorectal surgery on postoperative infections and anastomotic leakage.


METHODS
This is a retrospective analysis of prospectively collected data in a 3-year cohort of 162 patients undergoing elective resection of colon and or rectum. Of these patients, 76 (47%) received SDD (polymyxine B sulfate, tobramycin, and amphotericin) perioperatively. The control group consisted of 86 patients who were not treated with SDD. Postoperative complications, hospital stay, and mortality were analyzed.


RESULTS
In the SDD group, there were six patients (7.9%) with infectious complications compared with 17 patients (19.8%) in the control group (p = 0.031). The incidence of the combined endpoint infectious complications and anastomotic leakage was 8 (11%) in the SDD group vs. 22 (26%) in the control group (p = 0.014). Multivariate analysis showed that no-SDD, aged above 60 years and diabetes were independent predictors of postoperative complications.


CONCLUSIONS
Perioperative SDD in elective colorectal surgery seems to reduce postoperative surgical complications including infectious complications and anastomotic leakage. Prospective, randomized, placebo-controlled studies are needed to confirm this conclusion.
Roos
Daphne
D
Departement of Surgery, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands. docrossi@hotmail.com
Dijksman
Lea M
LM
Sondermeijer
Brigitte M
BM
Oudemans-van Straaten
Heleen M
HM
T de Wit
Laurens
L
Gerhards
Michael F
MF
D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage; D000714:Anastomosis, Surgical / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D003082:Colectomy / Q000009:adverse effects*; D003106:Colon / Q000601:surgery*; D016638:Critical Illness; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D017053:Infection Control; D008297:Male; D008875:Middle Aged; D011112:Polymyxin B / Q000008:administration & dosage; D011183:Postoperative Complications / Q000517:prevention & control; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D014031:Tobramycin / Q000008:administration & dosage
D000900:Anti-Bacterial Agents; D000666:Amphotericin B; D011112:Polymyxin B; D014031:Tobramycin