A statewide assessment of surgical site infection following colectomy: the role of oral antibiotics

Abstract

Objective: To determine the utility of adding oral nonabsorbable antibiotics to the bowel prep prior to elective colon surgery.

Summary background data: Bowel preparation prior to colectomy remains controversial. We hypothesized that mechanical bowel preparation with oral antibiotics (compared with without) was associated with lower rates of surgical site infection (SSI).

Methods: Twenty-four Michigan hospitals participated in the Michigan Surgical Quality Collaborative-Colectomy Best Practices Project. Standard perioperative data, bowel preparation process measures, and Clostridium difficile colitis outcomes were prospectively collected. Among patients receiving mechanical bowel preparation, a logistic regression model generated a propensity score that allowed us to match cases differing only in whether or not they had received oral antibiotics.

Results: Overall, 2011 elective colectomies were performed over 16 months. Mechanical bowel prep without oral antibiotics was administered to 49.6% of patients, whereas 36.4% received a mechanical prep and oral antibiotics. Propensity analysis created 370 paired cases (differing only in receiving oral antibiotics). Patients receiving oral antibiotics were less likely to have any SSI (4.5% vs. 11.8%, P = 0.0001), to have an organ space infection (1.8% vs. 4.2%, P = 0.044) and to have a superficial SSI (2.6% vs. 7.6%, P = 0.001). Patients receiving bowel prep with oral antibiotics were also less likely to have a prolonged ileus (3.9% vs. 8.6%, P = 0.011) and had similar rates of C. difficile colitis (1.3% vs. 1.8%, P = 0.58).

Conclusions: Most patients in Michigan receive mechanical bowel preparation prior to elective colectomy. Oral antibiotics may reduce the incidence of SSI.

Figure 1

Bowel preparation clinical practices within Michigan prior to elective colon surgery. Interestingly, the vast majority of patients still receive a mechanical bowel prep prior to elective colon surgery.

Figure 2

Bowel preparation clinical practices within Michigan; the specific types of bowel preparation prescribed prior to elective colon surgery.

Figure 3

Surgical site infection rates among propensity matched cohorts of patients who either did or did not receive oral non-absorbable antibiotics at the time of mechanical bowel preparation prior to elective colon surgery. Patients that received oral antibiotics were observed to have significantly lower rates of organ space infections, superficial surgical site infection, and overall surgical site infection rates.

Figure 4

Surgical site infection rates among propensity matched cohorts of patients who either did or did not receive oral non-absorbable antibiotics at the time of mechanical bowel preparation prior to elective colon surgery. Patients that received oral antibiotics were observed to have significantly lower rates of prolonged ileus and overall surgical site infection. Importantly, patient to receive oral antibiotics did not have significantly higher rates of C. difficile colitis.