title: The role of single-shot metronidazole in the prevention of Clostridium difficile infection following ileostomy reversal surgery.
abstract: OBJECTIVE
  Symptomatic infection with Clostridium difficile is strongly linked to antibiotic use and rates are higher for colorectal surgery. In February 2015, trust policy for antibiotic prophylaxis of ileostomy reversal surgery was changed from three doses of metronidazole plus cefuroxime to single-dose metronidazole, in a bid to reduce rates of Clostridium difficile infection.
  
  
  METHODS
  A retrospective cohort study was conducted at a single, large hospital trust between February 2014 and February 2016, before and after change in antimicrobial policy. Theatre data, clinical notes and pathology results were all reviewed. Outcome data, patient age, gender, length of operation and hospital stay were extracted.
  
  
  RESULTS
  One hundred three patients underwent ileostomy reversal surgery between February 2014 and February 2015. All received cefuroxime together with metronidazole at induction of anaesthesia followed by two further post-operative doses as operative prophylaxis. Ninety-six patients underwent ileostomy reversal surgery between February 2015 and February 2016. All received single-dose metronidazole at induction as prophylaxis. Post-operative diarrhoea was significantly reduced in patients given single-dose metronidazole compared with patients managed with multiple dose, dual antibiotic therapy (32 vs 12.5%, P 0.001). Rates of CDI were also significantly reduced in patients given single-dose metronidazole (6.8 vs 1%, P 0.038).
  
  
  CONCLUSIONS
  Single-dose, pre-operative metronidazole is effective at reducing post-operative diarrhoea and CDI in ileostomy reversal surgery compared with multiple-dose cefuroxime plus metronidazole. Metronidazole may be effective as a prophylactic antibiotic against CDI in colonic surgery.
authors.affiliation: Department of Surgery & Cancer, Queen Alexandra Hospital, Southwick Hill Rd, Portsmouth, PO6 3LY, UK.
authors.forename: Roland
authors.initials: R
authors.lastname: Fernandes
authors.affiliation: Department of Surgery & Cancer, Queen Alexandra Hospital, Southwick Hill Rd, Portsmouth, PO6 3LY, UK. drpauldrobinson@gmail.com.
authors.forename: Paul
authors.initials: P
authors.lastname: Robinson
authors.affiliation: Department of Surgery & Cancer, Queen Alexandra Hospital, Southwick Hill Rd, Portsmouth, PO6 3LY, UK.
authors.forename: Karan
authors.initials: K
authors.lastname: Rangarajan
authors.affiliation: Department of Surgery & Cancer, Queen Alexandra Hospital, Southwick Hill Rd, Portsmouth, PO6 3LY, UK.
authors.forename: Sophie
authors.initials: S
authors.lastname: Scott
authors.affiliation: Department of Surgery & Cancer, Queen Alexandra Hospital, Southwick Hill Rd, Portsmouth, PO6 3LY, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Angco
mesh_terms: D000328:Adult; D000368:Aged; D001427:Bacterial Toxins / Q000378:metabolism; D016360:Clostridioides difficile / Q000187:drug effects / Q000502:physiology*; D003015:Clostridium Infections / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control*; D003967:Diarrhea / Q000209:etiology; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects*; D008297:Male; D008795:Metronidazole / Q000494:pharmacology / Q000627:therapeutic use*; D008875:Middle Aged
chemical_list: D001427:Bacterial Toxins; D008795:Metronidazole
keywords: Clostridium difficile; Diarrhoea; Ileostomy; Metronidazole; Prophylaxis