Mechanical and oral antibiotic bowel preparation versus no bowel preparation in right and left colectomy: subgroup analysis of MOBILE trial.

Administration, Oral Aged Anti-Bacterial Agents / administration & dosage Antibiotic Prophylaxis / methods Cathartics / administration & dosage Colectomy / methods Elective Surgical Procedures Female Finland Humans Male Metronidazole / administration & dosage Middle Aged Neomycin / administration & dosage Preoperative Care / methods Single-Blind Method Surgical Wound Infection / prevention & control

Journal

BJS open
ISSN: 2474-9842
Titre abrégé: BJS Open
Pays: England
ID NLM: 101722685

Informations de publication

Date de publication:
05 03 2021
Historique:
received: 21 10 2020
accepted: 15 01 2021
entrez: 11 4 2021
pubmed: 12 4 2021
medline: 23 11 2021
Statut: ppublish

Résumé

In retrospective series, mechanical and oral antibiotic bowel preparation (MOABP) has been reported to reduce surgical-site infections (SSIs) after colectomy compared with no bowel preparation (NBP). This was a subgroup analysis of a multicentre randomized trial that included patients scheduled for elective colectomy. The MOABP group underwent mechanical bowel preparation, and took 2 g neomycin and 2 g metronidazole orally during the day before surgery. The NBP group did not undergo bowel preparation. Patients were categorized according to the side of resection (right versus left colectomy), and these subgroups compared for postoperative outcomes. Among 217 patients undergoing right colectomy (106 in MOABP and 111 in NBP group), SSI was detected in seven (7 per cent) and 10 (9 per cent) patients (odds ratio (OR) 0.71, 95 per cent c.i. 0.26 to 1.95; P = 0.510), anastomotic dehiscence in two (2 per cent) and two (2 per cent) patients (OR 1.05, 0.15 to 7.58; P = 1.000), and the mean(s.d.) Comprehensive Complication Index (CCI) score was 9.4(12.9) and 10.5(18.0) (mean difference -1.09; 95 per cent c.i. -5.29 to 3.11; P = 0.608) in the MOABP and NBP groups respectively. Among 164 patients undergoing left colectomy (84 in MOABP and 80 in NBP group), SSI was detected in five (6 per cent) and eight (10 per cent) patients (OR 0.57, 0.18 to 1.82; P = 0.338), anastomotic dehiscence in four (5 per cent) and five (6 per cent) patients (OR 0.75, 0.19 to 2.90; P = 0.742), and the CCI score was 10.2(13.1) and 6.5(11.0) (mean difference 3.68, -0.06 to 7.42; P = 0.053) in the MOABP and NBP groups respectively. MOABP did not decrease the rate of SSI or complications in patients undergoing either right or left colectomy compared with NBP.

Sections du résumé

BACKGROUND
In retrospective series, mechanical and oral antibiotic bowel preparation (MOABP) has been reported to reduce surgical-site infections (SSIs) after colectomy compared with no bowel preparation (NBP).
METHOD
This was a subgroup analysis of a multicentre randomized trial that included patients scheduled for elective colectomy. The MOABP group underwent mechanical bowel preparation, and took 2 g neomycin and 2 g metronidazole orally during the day before surgery. The NBP group did not undergo bowel preparation. Patients were categorized according to the side of resection (right versus left colectomy), and these subgroups compared for postoperative outcomes.
RESULTS
Among 217 patients undergoing right colectomy (106 in MOABP and 111 in NBP group), SSI was detected in seven (7 per cent) and 10 (9 per cent) patients (odds ratio (OR) 0.71, 95 per cent c.i. 0.26 to 1.95; P = 0.510), anastomotic dehiscence in two (2 per cent) and two (2 per cent) patients (OR 1.05, 0.15 to 7.58; P = 1.000), and the mean(s.d.) Comprehensive Complication Index (CCI) score was 9.4(12.9) and 10.5(18.0) (mean difference -1.09; 95 per cent c.i. -5.29 to 3.11; P = 0.608) in the MOABP and NBP groups respectively. Among 164 patients undergoing left colectomy (84 in MOABP and 80 in NBP group), SSI was detected in five (6 per cent) and eight (10 per cent) patients (OR 0.57, 0.18 to 1.82; P = 0.338), anastomotic dehiscence in four (5 per cent) and five (6 per cent) patients (OR 0.75, 0.19 to 2.90; P = 0.742), and the CCI score was 10.2(13.1) and 6.5(11.0) (mean difference 3.68, -0.06 to 7.42; P = 0.053) in the MOABP and NBP groups respectively.
CONCLUSIONS
MOABP did not decrease the rate of SSI or complications in patients undergoing either right or left colectomy compared with NBP.

Identifiants

DOI: 10.1093/bjsopen/zrab011 PMID: 33839753 PMC: PMC8038265
pubmed: 33839753
pii: 6220257
doi: 10.1093/bjsopen/zrab011
pmc: PMC8038265
pii:
doi:

Substances chimiques

Anti-Bacterial Agents 0
Cathartics 0
Metronidazole 140QMO216E
Neomycin I16QD7X297

Types de publication

Journal Article Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.

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Auteurs

L Koskenvuo (L)

Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

T Lehtonen (T)

Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

S Koskensalo (S)

Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

S Rasilainen (S)

Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

K Klintrup (K)

Department of Surgery, Surgical Research Unit, Medical Research Centre, Oulu University Hospital, University of Oulu, Oulu, Finland.

A Ehrlich (A)

Department of Surgery, Central Hospital of Central Finland, Jyväskylä, Finland.

T Pinta (T)

Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland.

T Scheinin (T)

Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

V Sallinen (V)

Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

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Classifications MeSH

questionsmedicales.fr › Thérapeutique › Traitement médicamenteux › Voies d'administration de substances chimiques et des médicaments › Administration par voie orale › Mechanical and oral antibiotic bowel...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Mechanical and oral antibiotic bowel...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antibactériens › Mechanical and oral antibiotic bowel...
questionsmedicales.fr › Thérapeutique › Traitement médicamenteux › Prémédication › Antibioprophylaxie › Mechanical and oral antibiotic bowel...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents gastro-intestinaux › Cathartiques › Mechanical and oral antibiotic bowel...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie digestive › Colectomie › Mechanical and oral antibiotic bowel...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales non urgentes › Mechanical and oral antibiotic bowel...
questionsmedicales.fr › Régions géographiques › Europe › Pays nordiques et scandinaves › Finlande › Mechanical and oral antibiotic bowel...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Mechanical and oral antibiotic bowel...
questionsmedicales.fr › Composés hétérocycliques › Composés hétéromonocycliques › Azoles › Imidazoles › Nitroimidazoles › Métronidazole › Mechanical and oral antibiotic bowel...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Mechanical and oral antibiotic bowel...
questionsmedicales.fr › Glucides › Hétérosides › Aminosides › Néomycine › Mechanical and oral antibiotic bowel...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Soins périopératoires › Soins préopératoires › Mechanical and oral antibiotic bowel...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Méthodologie en recherche épidémiologique › Méthode en simple aveugle › Mechanical and oral antibiotic bowel...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Infection de plaie opératoire › Mechanical and oral antibiotic bowel...