Antibiotics, Mechanical Bowel Preparation Associated With Reduced SSIs

A combination of oral antibiotics and mechanical bowel preparation (MBP) was associated with a decrease in surgical site infections (SSIs) in patients undergoing left colon and rectal cancer resections, according to a study published in Surgery.

Post colorectal surgery SSI is a specific concern for people with cancer because infections often delay time to adjuvant therapies, possibly decreasing overall cancer survival. Evidence that oral antibiotics and MBP reduce infections exists, but the practice has not been widely adopted.

A review of data collected from a single institution between October 1, 2013, and December 31, 2016, identified 89 patients undergoing left colon and rectal cancer resections, 49 of whom received only MBP and 40 of whom received MBP and oral antibiotic treatment.

Overall SSI rates were lower in the MBP and antibiotics group than in the MBP-only group, 8% vs 27%, respectively (P =.03). There was no difference, however, in median days to adjuvant therapy: 60 days [interquartile range, 46-73 days] for the MBP-only cohort vs 72 days [interquartile range, 59-85 days] for the oral antibiotics and MBP cohort (P =.13).

Two variables were associated with reduced odds of SSI in a multivariate analysis: oral antibiotics and MBP (odds ratio [OR] 0.11; 95% CI, 0.02-0.86; P =.04) and minimally invasive surgery (OR 0.22; 95% CI, 0.05-0.89; P =.03).

This study was limited to patients from a small single-site veteran population, limiting the external validity of the findings. Despite this, the results highlight the need for trials to confirm the benefits of oral antibiotics and MBP. Researchers also suggest that future work question whether the benefits “are also present for patients undergoing right colon resections,” and that until such time, “clinicians should consider using oral antibiotics and MBP for all patients undergoing left-sided colorectal cancer resections.”

Reference

Vo E, Massarweh NN, Chai CY, et al. Association of the addition of oral antibiotics to mechanical bowel preparation for left colon and rectal cancer resections with reduction of surgical site infections [published online October 18, 2017]. JAMA Surg. doi: 10.1001/jamasurg.2017.3827