Antimicrobial formulation and delivery in the prevention of surgical site infection

O'Neal PB, Itani KM

"Proper dosing and re-dosing of prophylactic intravenous antibiotics should become standard practice. Continuation of intravenous antibiotic prophylaxis beyond wound closure is unnecessary in clean cases and remains controversial in clean-contaminated and complex cases. Oral antibiotic bowel preparation is an important adjunct to intravenous antibiotic prophylaxis in colorectal surgery. The use of topical antimicrobial and antiseptic agents such as antibacterial irrigations, local antimicrobial application, antimicrobial-coated sutures, antibacterial wound sealants, and antimicrobial impregnated dressings in the prevention of SSI is questionable."

Surgical site infection and its risk factors in colon surgeries

Fusco Sde F, Massarico NM, Alves MV, Fortaleza CM, Pavan ÉC, Palhares Vde C, Melo CE, Avila MA, Nitsche MJ

"The understanding of health professionals about the factors that influence the incidence of SSI in colon surgery may contribute to the quality of care provided to surgical patients, from effective actions to minimize the risk of infections."

Comparing mechanical bowel preparation with both oral and systemic antibiotics versus mechanical bowel preparation and systemic antibiotics alone for the prevention of surgical site infection after elective colorectal surgery

Chen M, Song X, Chen LZ, Lin ZD, Zhang XL

"Oral systemic antibiotics and mechanical bowel preparation significantly lowered the incidence of surgical site infection after elective colorectal surgery compared with systemic antibiotics alone and mechanical bowel preparation."

Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery

Kiran RP, Murray AC, Chiuzan C, Estrada D, Forde K

"These data clarify the near 50-year debate whether bowel preparation improves outcomes after colorectal resection. MBP with oral antibiotics reduces by nearly half, SSI, anastomotic leak, and ileus, the most common and troublesome complications after colorectal surgery."

Organizational culture changes result in improvement in patient-centered outcomes: Implementation of an integrated recovery pathway for surgical patients

Wick EC, Galante DJ, Hobson DB, Benson AR, Lee KH, Berenholtz SM, Efron JE, Pronovost PJ, Wu CL

"Our trust-based accountability model, which included both senior hospital leadership and frontline providers, provided an enabling structure to rapidly implement an integrated recovery pathway and quickly improve outcomes, value, and experience of patients undergoing colorectal surgery. The study findings have significant implications for spreading surgical quality improvement work."

Combined mechanical and oral antibiotic bowel preparation reduces incisional surgical site infection and anastomotic leak rates after elective colorectal resection: An analysis of colectomy-targeted ACS NSQIP

Scarborough JE, Mantyh CR, Sun Z, Migaly J

"Combined bowel preparation with mechanical cleansing and oral antibiotics results in a significantly lower incidence of incisional surgical site infection, anastomotic leakage, and hospital readmission when compared to no preoperative bowel preparation."

[Impact of preoperative bowel preparation on prevention of surgical site infection]

Kobayashi M, Kusunoki M

"Recently, several large retrospective studies have demonstrated that MBP plus [Oral Antibiotic Bowel Prep] is associated with reduced postoperative infectious complications including surgical site infection rates after elective colorectal surgery. Further prospective, randomized trials of MBP and OABP alone and in combination should be conducted."

Nationwide analysis of outcomes of bowel preparation in colon surgery

Moghadamyeghaneh Z, Hanna MH, Carmichael JC, Mills SD, Pigazzi A, Nguyen NT, Stamos MJ

"Our analysis revealed that solitary mechanical bowel preparation and solitary oral bowel preparation had no significant effects on major postoperative complications after colon cancer resection. However, a combination of mechanical and oral antibiotic preparations showed a significant decrease in postoperative morbidity."

Prevention of infectious complications after elective colorectal surgery in children: An American Pediatric Surgical Association Outcomes and Clinical Trials Committee comprehensive review

Rangel SJ, Islam S, St Peter SD, Goldin AB, Abdullah F, Downard CD, Saito JM, Blakely ML, Puligandla PS, Dasgupta R, Austin M, Chen LE, Renaud E, Arca MJ, Calkins CM

"Clinical evidence in support of interventions to reduce infectious complications following colorectal surgery is derived almost exclusively from the adult literature. High-quality evidence to guide clinical practice in children is sorely needed, as the available data may have only limited relevance to pediatric colorectal diseases."

Oral mechanical bowel preparation for colorectal surgery [Internet]

Dahabreh IJ, Steele DW, Shah N, Trikalinos TA

"We found weak evidence suggesting that OMBP has similar effectiveness as no preparation with respect to all-cause mortality, anastomotic leakage, wound infection, and peritonitis for patients undergoing elective colorectal surgery. However, the evidence base was too weak to confidently exclude either modest benefit or modest harm. Evidence for other outcomes and comparisons was insufficient to draw definitive conclusions. The effectiveness of alternative active OMBP strategies could not be assessed because the studies compared interventions that are no longer used. Data on harms were also too sparse for analysis. Therefore, there is a clear need for new comparative studies (both randomized and nonrandomized) of the currently used OMBP strategies. "

A statewide colectomy experience: The role of full bowel preparation in preventing surgical site infection

Kim EK, Sheetz KH, Bonn J, DeRoo S, Lee C, Stein I, Zarinsefat A, Cai S, Campbell DA Jr, Englesbe MJ

"In the state of Michigan, full bowel preparation is associated with decreased infectious complications after elective colectomy. Within this context, the Michigan Surgical Quality Collaborative recommends full bowel preparation before elective colectomy."

Elimination of preoperative mechanical bowel preparation in patients undergoing cystectomy and urinary diversion

Raynor MC, Lavien G, Nielsen M, Wallen EM, Pruthi RS

"Preoperative mechanical bowel preparation prior to radical cystectomy with urinary diversion does not demonstrate any significant advantage in perioperative outcomes, including gastrointestinal complications. Further studies aimed at measuring patient satisfaction and larger randomized trials will be beneficial in evaluating the role of mechanical bowel preparation prior to urinary diversion."

Mechanical bowel preparation before elective colorectal surgery: is it necessary?

Matsou A, Vrakas G, Doulgerakis M, Hatzimisios K, Zandes N, Saliangas K

A retrospective review of 5 randomized controlled trials and 2 meta-analyses suggest omitting mechanical bowel preparation because there are no significant differences in postoperative infectious complications, such as anastomotic dehiscence and superficial surgical site infection.

Colon preparation and surgical site infection

Fry DE

A review of published literature demonstrated that mechanical bowel preparation alone does not reduce surgical site infection rates. Compared with systemic antibiotics alone, oral antibiotic preparation and systemic preoperative antibiotics are superior.

Combination of oral non-absorbable and intravenous antibiotics versus intravenous antibiotics alone in the prevention of surgical site infections after colorectal surgery: a meta-analysis of randomized controlled trials

Bellows CF, Mills KT, Kelly TN, Gagliardi G

A meta-analysis of 16 randomized controlled trials found that use of oral nonabsorbable antibiotics in addition to intravenous antibiotics after mechanical bowel preparation significantly lowered the risk of surgical wound infections compared to intravenous antibiotics alone.

Mechanical bowel preparation for elective colorectal surgery

Güenaga KF, Matos D, Wille-Jørgensen P

A review of 18 randomized controlled trials with 5,805 participants determined there is no statistically significant evidence that patients benefit from mechanical bowel preparation or the use of rectal enemas. For colonic surgery, bowel cleansing can be safely omitted without inducing a higher complication rate; for rectal surgery, mechanical bowel preparation can be used selectively, although no significant effect was found.

Evaluating an Evidence-Based Bundle for Preventing Surgical Site Infection: A Randomized Trial

Anthony T, Murray BW, Sum-Ping JT, Lenkovsky F, Vornik VD, Parker BJ, McFarlin JE, Hartless K, Huerta S

A single-institution, randomized controlled trial of 197 patients undergoing elective transabdominal colorectal surgery compared the overal SSI rate at 30 days for a standard arm with treatment according to the institution's current practice versus an extended arm treated with 5 evidence-based practices. The study found that the evidence-based intervention bundle, which ommitted mechanical bowel preparation, did not reduce surgical site infections.

Mechanical bowel preparation in elective colorectal surgery

Khan SA, Hadi A, Ahmad S, Shah FO, Iqbal Z, Khan M

A prospective study with 102 patients undergoing elective colorectal procedures found that mechanical bowel preparation does not offer any benefits in relation to anastomotic leak rate, infective and other complications.

Preoperative bowel preparation for patients undergoing elective colorectal surgery: a clinical practice guideline endorsed by the Canadian Society of Colon and Rectal Surgeons

Eskicioglu C, Forbes SS, Fenech DS, McLeod RS; For the Best Practice in General Surgery Committee

A review of 14 randomized controlled trials and 8 meta-analyses of patients undergoing elective colorectal surgery suggests that mechanical bowel preparation (MBP) should be omitted based on the adverse effects of MBP and the lack of difference in postoperative infectious complication rates when it is omitted.

Rectal Cancer Surgery With or Without Bowel Preparation: The French Greccar III Multicenter Single-Blinded Randomized Trial

Bretagnol F, Panis Y, Rullier E, Rouanet P, Berdah S, Dousset B, Portier G, Benoist S, Chipponi J, Vicaut E; French Research Group of Rectal Cancer Surgery (GRECCAR)

A single-blinded, multicenter randomized trial of 178 patients undergoing sphincter-saving rectal resection for cancer demonstrated that the exclusion of mechanical bowel preparation (MBP) for rectal cancer was associated with higher overall risks and infectious morbidity rates without any significant increase of anastomotic leakage rate. It suggested continuing to perform MBP before elective rectal resection for cancer.

Incidence of Surgical Site Infections Postcolorectal Resections without Preoperative Mechanical or Antibiotic Bowel Preparation

Howard DD, White CQ, Harden TR, Ellis CN

A retrospective review of 136 medical records of consecutive patients undergoing elective colorectal resections found that administration of perioperative antibiotics within 1 hour before surgery is associated with a significant decrease in SSI incidence Bowel preparation (mechanical and antibiotic) can be safely omitted.

Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial

Contant CM, Hop WC, van't Sant HP, Oostvogel HJ, Smeets HJ, Stassen LP, Neijenhuis PA, Idenburg FJ, Dijkhuis CM, Heres P, van Tets WF, Gerritsen JJ, Weidema WF

A multicenter, randomized non-inferiority study including 1,354 patients advised that mechanical bowel preparation before elective colorectal surgery can safely be abandoned after finding no significant difference in anastomotic leakage, other septic complications, fascia dehiscence and mortality between the bowel preparation and non-bowel preparation group.

The use of mechanical bowel preparation in elective colorectal surgery

McCoubrey AS

A review of the literature led authors to recommend that colorectal surgery is safe without pre-operative mechanical bowel preparation, but there may be some situations in which it would be beneficial. Because there is not enough strength of evidence at present to recommend a change in practice, there is a need for further higher powered trials.

Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection

Jung B, Påhlman L, Nyström PO, Nilsson E; Mechanical Bowel Preparation Study Group

A randomized trial of 1,343 patients undergoing elective colorectal surgery found no significant differences in overall complications between the mechanical bowel preparation (MBP) and no MBP groups, thus suggesting that MBP can be omitted before elective colonic resection.

Mechanical Bowel Preparation for Colorectal Surgery

Rovera F, Dionigi G, Boni L, Ferrari A, Bianchi V, Diurni M, Carcano G, Dionigi R

A review of randomized trials and a Cochrane review found no proof that mechanical bowel preparation reduces the risk of complications after elective colorectal surgery and found evidence that it is associated with higher anastomic leakage and wound complication rates. On the other hand, the preparation decreased operating time by improving bowel handling during construction of the anastomosis and aided in intestinal palpation for identifiying a lesion.

Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation

Slim K, Vicaut E, Panis Y, Chipponi J

A meta-analysis of seven randomized clinical trials of 1,454 patients undergoing colorectal surgery found significantly more anastomotic leakage after mechanical bowel preparation (MBP) with polyethylene glycol (PEG) versus no preparation, suggesting that this form of MBP should be omitted before elective colorectal surgery.

Oral versus systemic antibiotic prophylaxis in elective colon surgery: a randomized study and meta-analysis send a message from the 1900s

Lewis RT

A double-blinded, placebo-controlled, randomized clinical trial of 215 patients undergoing elective colon surgery compared the efficacy in preventing surgical site infection by combined oral and systemic antibiotics versus systemic antibiotics alone. The study concluded that combined oral and systemic antibiotics are superior to systemic antibiotics alone in preventing surgical site infection. A meta-analysis of 13 randomized studies supported these results.

The prevention of wound infection in patients undergoing colorectal surgery

Platell C, Hall JC

A review of clinical trials and meta-analyses supports the prophylactic use of a single dose of a suitable parenteral antimicrobial agent for colorectal operations. The evidence appears to show that mechanical bowel preparation does not reduce the incidence of wound infection after colorectal surgery.