title: Preoperative oral antibiotics and intravenous antimicrobial prophylaxis reduce the incidence of surgical site infections in patients with ulcerative colitis undergoing IPAA.
abstract: BACKGROUND
  The usefulness of preoperative oral antibiotics for the prevention of surgical site infection in elective colorectal surgery remains controversial.
  
  
  OBJECTIVE
  This study aimed to investigate the effects of oral antimicrobial prophylaxis in addition to intravenous antimicrobial prophylaxis on patients with ulcerative colitis undergoing restorative proctocolectomy.
  
  
  METHODS
  This study was a randomized, nonblinded, single-center clinical trial.
  
  
  METHODS
  This study was conducted between July 1, 2006, and April 30, 2009, at Hyogo College of Medicine.
  
  
  METHODS
  Two hundred patients with ulcerative colitis scheduled to undergo restorative proctocolectomy with IPAA with an open approach were randomly assigned to either group A or B (n = 100). Combined use of preoperative oral antibiotics and intravenous antimicrobial prophylaxis were given to group A, and intravenous antimicrobial prophylaxis alone was given to group B.
  
  
  METHODS
  Patients in group A received oral antibiotics the day before surgery (500 mg of kanamycin and 500 mg of metronidazole at 2:00 P.M., 3:00 P.M., and 9:00 P.M.), whereas those in group B did not. All patients underwent preoperative mechanical bowel preparation, and intravenous antimicrobial prophylaxis with second-generation cephalosporin was given for 24 hours.
  
  
  METHODS
  The primary end point of this study was the incidence of overall surgical site infection according to intention-to-treat analysis.
  
  
  RESULTS
  The incidence of overall surgical site infection was significantly lower in group A (6/97 patients, 6.1%) than in group B (22/98 patients, 22.4%) (p = 0.0024). In multivariate analysis, the administration of oral antibiotics (OR, 0.178; 95% CI, 0.057-0.552; p = 0.003) and ASA score ≥3 (OR, 5.343; 95% CI, 1.595-17.891; p = 0.007) were independent risk factors for surgical site infection.
  
  
  CONCLUSIONS
  This study is limited because of its open-label nature.
  
  
  CONCLUSIONS
  Combined oral and intravenous antimicrobial prophylaxis in patients with ulcerative colitis undergoing restorative proctocolectomy with IPAA contributed to the prevention of surgical site infection.
authors.affiliation: 1 Department of Surgery, Hyogo College of Medicine, Mukogawa-cho, Nishinomiya-shi, Hyogo, Japan 2 Department of Infection Control and Prevention, Hyogo College of Medicine, Mukogawa-cho, Nishinomiya-shi, Hyogo, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Oshima
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Takesue
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ikeuchi
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsuoka
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakajima
authors.forename: Motoi
authors.initials: M
authors.lastname: Uchino
authors.forename: Naohiro
authors.initials: N
authors.lastname: Tomita
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Sasako
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D002511:Cephalosporins / Q000008:administration & dosage; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007612:Kanamycin / Q000008:administration & dosage; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage; D008875:Middle Aged; D016737:Proctocolectomy, Restorative; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D008795:Metronidazole; D007612:Kanamycin; C045693:flomoxef