A statewide assessment of surgical site infection following colectomy: the role of oral antibiotics.
OBJECTIVE
To determine the utility of adding oral nonabsorbable antibiotics to the bowel prep prior to elective colon surgery.


BACKGROUND
Bowel preparation prior to colectomy remains controversial. We hypothesized that mechanical bowel preparation with oral antibiotics (compared with without) was associated with lower rates of surgical site infection (SSI).


METHODS
Twenty-four Michigan hospitals participated in the Michigan Surgical Quality Collaborative-Colectomy Best Practices Project. Standard perioperative data, bowel preparation process measures, and Clostridium difficile colitis outcomes were prospectively collected. Among patients receiving mechanical bowel preparation, a logistic regression model generated a propensity score that allowed us to match cases differing only in whether or not they had received oral antibiotics.


RESULTS
Overall, 2011 elective colectomies were performed over 16 months. Mechanical bowel prep without oral antibiotics was administered to 49.6% of patients, whereas 36.4% received a mechanical prep and oral antibiotics. Propensity analysis created 370 paired cases (differing only in receiving oral antibiotics). Patients receiving oral antibiotics were less likely to have any SSI (4.5% vs. 11.8%, P = 0.0001), to have an organ space infection (1.8% vs. 4.2%, P = 0.044) and to have a superficial SSI (2.6% vs. 7.6%, P = 0.001). Patients receiving bowel prep with oral antibiotics were also less likely to have a prolonged ileus (3.9% vs. 8.6%, P = 0.011) and had similar rates of C. difficile colitis (1.3% vs. 1.8%, P = 0.58).


CONCLUSIONS
Most patients in Michigan receive mechanical bowel preparation prior to elective colectomy. Oral antibiotics may reduce the incidence of SSI.
Englesbe
Michael J
MJ
Department of Surgery, University of Michigan, Ann Arbor, MI 48109-5331, USA. englesbe@umich.edu
Brooks
Linda
L
Kubus
James
J
Luchtefeld
Martin
M
Lynch
James
J
Senagore
Anthony
A
Eggenberger
John C
JC
Velanovich
Vic
V
Campbell
Darrell A
DA
D000284:Administration, Oral; D000368:Aged; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002400:Cathartics / Q000008:administration & dosage; D016009:Chi-Square Distribution; D003082:Colectomy; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008824:Michigan / Q000453:epidemiology; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*
D000900:Anti-Bacterial Agents; D002400:Cathartics