Jeffrey A Ling, MD1, Jason C Mccartt, MD2, Pamela L Burgess, MD1, Christopher W Mangieri, MD1. 1Eisenhower Army Medical Center, 2Womack Army Medical Center
Background: Mechanical bowel preparation given with oral antibiotics prior to elective colectomy has been shown to decrease the rates of surgical site infections and anastomotic leaks. The combination of mechanical bowel prep and oral antibiotics confers greater benefit than either of them alone. However, a concern with oral antibiotics is the potential higher risk of developing a Clostridium difficile infection (CDI) post-operatively. CDI is a devastating complication following colorectal surgery, with patients suffering disruption of their anastomoses, higher rates of reoperation, higher mortality rates, ICU admission, and readmission. Given the concern for increased CDI rates with oral antibiotic preps, we attempted to determine whether administration of oral antibiotics truly is associated with higher rates of CDI in patients following elective colectomy.
Methods: Data on elective colectomies from the National Surgical Quality Improvement Program (NSQIP) registry, for the years 2015-2016, was collected and categorized according to type of bowel preparation (oral antibiotics with mechanical bowel preparation, oral antibiotics alone, mechanical bowel preparation alone, and no preparation), presence of CDI postoperatively and anastomotic leak.
Results: Oral antibiotics were associated with decreased rates of CDI (0.53% [0.51%-0.55%]; P<.01). This decrease was sustained both with mechanical bowel preparation (0.54% [0.52%-0.56%}; P<.01) and without mechanical preparation (0.22% [0.18%-0.26%]; P<.01) although the benefit was slightly less in the latter group. Coadministration of oral antibiotics with mechanical preparation was also associated with a decreased risk of anastomotic leak (1.48% [1.46%-1.50%]; P<.01) as compared to mechanical preparation alone.
Conclusion: Preoperative oral antibiotics are not associated with increased rates of CDI in patients receiving elective colectomy and in fact are associated with a decreased rate of CDI. Our findings support the use of a combined mechanical and oral antibiotic prep in patients undergoing an elective colectomy to allow them the optimal outcome following surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94922
Program Number: S034
Presentation Session: Colorectal I
Presentation Type: Podium