Oral Antibiotic Prophylaxis Reduces Surgical Site Infection and Anastomotic Leakage in Patients Undergoing Colorectal Cancer Surgery
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Selection of Articles
2.3. Endpoints
2.4. Antibiotic Definitions
2.5. Data Extraction and Management
2.6. Statistical Analysis
3. Results
3.1. Quality Assessment and Patient Demographics
3.1.1. Antibiotic Regimes
3.1.2. MBP
3.1.3. Type of Surgery
3.2. Primary Outcome: Anastomotic Leakage and Surgical Site Infection
3.2.1. Anastomotic Leakage (AL)
3.2.2. Surgical Site Infection (SSI)
3.2.3. Subgroup Analysis: SDD versus Broad-Spectrum OABs
4. Discussion
5. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
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Reference and Year of Publication | Study Methodology | Number of Patients | Intervention Group (N) | Control Group (N) | Endpoint SSI | Endpoint AL | Type of Resection | Laparoscopic/Open Surgery | OAB Agent | MBP Agent | Intravenous (i.v) Antibiotics | Comparison Included |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Takesue et al., 2000 [35] | RCT | 83 | 38 | 45 | Yes | Yes | Ileocecal resection–5 Right colectomy–14 Left colectomy–3 Transverse colectomy–6 Sigmoidectomy–24 LAR–24 Miles’ APR–7 | Open | Kanamycin 500 mg + Metronidazole 500 mg at 2 p.m., 3 p.m. and 11 p.m. when surgery was scheduled on 9 a.m. + control group treatment | Polyethylene glycol at 10 a.m. the day before surgery | Cefmetazole 1 g after induction of anesthesia, administered three times a day for 3 consecutive days | MBP + OAB vs. MBP |
Ishida et al., 2001 [36] | RCT | 143 | 72 | 71 | Yes | Yes | Colectomy–76 Anterior resection–47 APR–9 Total proctectomy with J pouch–3 Total pelvic exenteration–4 Other–4 | Unknown | Kanamycin 500 mg + Erythromycin 400 mg in 4 daily doses, started 2 days preoperatively + control group treatment | Polyethylene glycol 2 L given the day before surgery | Cefotiam 1 g in 2 daily doses for 48 h | MBP+OAB vs. MBP |
Kobayashi et al., 2007 [37] | RCT | 484 | 242 | 242 | Yes | No | Surgical procedure: Colon–241 Rectum–243 | Unknown | Kanamycin 1 gr + Erythromicin 400 mg at 14:00, 15:00, and 23:00 + control group treatment | Polyethylene glycol 2 L given the day before surgery | Cefmetazole 1 g after the induction of anesthesia, additional dose if the operation was prolonged beyond 3 h. Again twice daily for 3 consecutive days | MBP+OAB vs. MBP |
Roos et al., 2009 [40] | Cohort | 162 | 76 | 86 | Yes | Yes | Hemicolectomy (right sided)–42 Hemicolectomy (left sided)–15 Transversectomy–4 (Subtotal) colectomy–3 Sigmoid resection–38 LAR–43 | Combination | Polymyxin B sulphate 100 mg + Tobramycin 80 mg + Amphotericin B 500 mg 4 daily doses, started 2 days preoperatively + control group treatment | Two to 4 L of Klean-Prep® were administered in 24 h and/or a fluid diet was given starting 1 day before surgery. In rectal surgery, also an enema was applied | Cefuroxime 1500 mg + metronidazole 500 mg 3 doses in 24 h | MBP+OAC vs. MBP |
Hata et al., 2016 [38] | RCT | 579 | 289 | 290 | No | Yes | Colectomy–376 Anterior resection–183 APR–20 | Laparoscopic | Kanamycin 1 g + Metronidazole 750 mg at 13 h and 9 h before the surgery + control group treatment | Sodium picosulphate 75 mg and magnesium citrate 34 g with 180 mL water the day before surgery | Cefmetazole 1 g was administered intravenously 30 min before the skin incision, additional dose was given every 3 h during the surgery | MBP+OAB vs. MBP |
Ikeda et al., 2016 [39] | RCT | 511 | 255 | 256 | No | Yes | Colonic surgery–309 Anterior resection–177 APR–25 | Laparoscopic | Kanamycin 1000 mg 2 doses + Metronidazole 750 mg, started 1 day preoperative + control group treatment | Magnesium citrate and sodium picosulphate the day before surgery | Cefmetazole 1 g 3 doses in 24 h | MBP+OAB vs. MBP |
Abis et al., 2019 [17] | RCT | 455 | 228 | 227 | Yes | Yes | Right hemicolectomy–162 Transverse colectomy–17 Left hemicolectomy–41 Sigmoid resection–124 Low anterior resection–103 Other–8 | Combination 98.2% laparo-scopic and 1.8% open in both groups | SDD 3 days prior to surgery until 3 days after surgery or when normal bowel motion occured + control group treatment | Klean-Prep | Cefazoline 1 gr + Metronidazol 500 mg, intravenously, 30 min prior to skin incision | MBP+OAB vs. MBP |
Schardey et al., 2020 [41] | RCT | 80 | 40 | 40 | Yes | Yes | (low anterior resection with TME–80 | Unknown | Polymyxin B sulphate 100 mg + Tobramycin 80 mg + Vancomycin 125 mg + Amphotericin B 500 mg 4 daily doses, started 1 day preoperatively till day 7 postoperatively. | Klean-Prep | Amphotericin B 500 mg + Lactulose 305 mg | MBP+OAB vs. MBP |
Reference | Random Sequence Generation | Allocation Concealment | Blinding of Participant and Personnel | Blinding of Outcome Assessment | Incomplete Outcome Data | Selective Reporting |
---|---|---|---|---|---|---|
Takesue et al. [35] | unclear | unclear | unclear | unclear | high | unclear |
Ishida et al. [36] | low | high | high | high | low | unclear |
Kobayashi et al. [37] | low | unclear | high | high | high | high |
Hata et al. [38] | low | low | high | high | low | low |
Ikeda et al. [39] | low | low | high | low | low | low |
Abis et al. [17] | low | low | high | low | low | low |
Schardey et al. [41] | low | low | low | low | high | high |
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Grewal, S.; Reuvers, J.R.D.; Abis, G.S.A.; Otten, R.H.J.; Kazemier, G.; Stockmann, H.B.A.C.; van Egmond, M.; Oosterling, S.J. Oral Antibiotic Prophylaxis Reduces Surgical Site Infection and Anastomotic Leakage in Patients Undergoing Colorectal Cancer Surgery. Biomedicines 2021, 9, 1184. https://doi.org/10.3390/biomedicines9091184
Grewal S, Reuvers JRD, Abis GSA, Otten RHJ, Kazemier G, Stockmann HBAC, van Egmond M, Oosterling SJ. Oral Antibiotic Prophylaxis Reduces Surgical Site Infection and Anastomotic Leakage in Patients Undergoing Colorectal Cancer Surgery. Biomedicines. 2021; 9(9):1184. https://doi.org/10.3390/biomedicines9091184
Chicago/Turabian StyleGrewal, Simran, J. Reinder D. Reuvers, Gabor S. A. Abis, René H. J. Otten, Geert Kazemier, Hein B. A. C. Stockmann, Marjolein van Egmond, and Steven J. Oosterling. 2021. "Oral Antibiotic Prophylaxis Reduces Surgical Site Infection and Anastomotic Leakage in Patients Undergoing Colorectal Cancer Surgery" Biomedicines 9, no. 9: 1184. https://doi.org/10.3390/biomedicines9091184