Effect of preoperative oral antibiotics and mechanical bowel preparation on the prevention of surgical site infection in elective colorectal surgery, and does oral antibiotic regime matter? a bayesian network meta-analysis.
Humans
Anti-Bacterial Agents
/ therapeutic use
Surgical Wound Infection
/ etiology
Metronidazole
Colorectal Surgery
/ adverse effects
Network Meta-Analysis
Cathartics
/ therapeutic use
Antibiotic Prophylaxis
Neomycin
Preoperative Care
/ adverse effects
Elective Surgical Procedures
/ adverse effects
Administration, Oral
Colorectal surgery
Mechanical bowel preparation
Network meta-analysis
Oral antibiotics
Surgical site infection
Journal
International journal of colorectal disease
ISSN: 1432-1262
Titre abrégé: Int J Colorectal Dis
Pays: Germany
ID NLM: 8607899
Informations de publication
Date de publication:
31 May 2023
31 May 2023
Historique:
accepted:
24
05
2023
medline:
2
6
2023
pubmed:
31
5
2023
entrez:
31
5
2023
Statut:
epublish
Résumé
Surgical site infection (SSI) impacts 5-20% of patients after elective colorectal surgery. There are varying reports on the effectiveness of oral antibiotics (OAB) with preoperative mechanical bowel preparation (MBP) in preventing SSI. We aim to determine the role of OAB and MBP in preventing SSI after elective colorectal surgery. We also determine if a specific OAB regimen will be more effective than others. This study investigated the impact of OAB and MBP in patients undergoing elective colorectal surgery. PubMed, MEDLINE, Ovid, Cochrane Central Register of Controlled Trials, ACP Journal Club, and Embase databases were searched for randomized clinical trials (RCTs) published by June 2022. All RCTs comparing various preoperative bowel preparation regimens, including pairwise or multi-intervention comparisons, were included. To establish the role of OAB and MBP in preventing SSI, we conducted a Bayesian network meta-analysis on all RCTs. We further performed subgroup analysis to determine the most effective OAB regimen. Among included 46 studies with a total of 12690 patients, patients in the MBP + OAB group were less likely to have SSI than those having MBP-only (OR 0.55, 95% CrI 0.39-0.76), and without MBP and OAB (OR 0.52, 95% CrI 0.32-0.84). OAB regimen C (kanamycin + metronidazole) and A (neomycin + metronidazole) demonstrated a significantly reduced incidence of SSI, compared to regimen B (neomycin + erythromycin) with OR 0.24 (95% CrI 0.07-0.79) and 0.26 (95% CrI 0.07-0.99) respectively. OAB with MBP reduces the risk of SSI after elective colorectal surgery. Providing adequate aerobic and anaerobic coverage with OAB may confer better protection against SSI.
Identifiants
pubmed: 37256453
doi: 10.1007/s00384-023-04444-3
pii: 10.1007/s00384-023-04444-3
doi:
Substances chimiques
Anti-Bacterial Agents
0
Metronidazole
140QMO216E
Cathartics
0
Neomycin
I16QD7X297
Types de publication
Meta-Analysis
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
151Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
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