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Observational Study
. 2021 Sep;36(9):1839-1849.
doi: 10.1007/s00384-021-03931-9. Epub 2021 Apr 25.

Mechanical plus oral bowel preparation with paromomycin and metronidazole reduces infectious complications in elective colorectal surgery: a matched case-control study

Matthias Mehdorn  1 , Christoph Lübbert  2   3 , Iris F Chaberny  3   4 , Ines Gockel  1 , Boris Jansen-Winkeln  5
Affiliations
Observational Study

Mechanical plus oral bowel preparation with paromomycin and metronidazole reduces infectious complications in elective colorectal surgery: a matched case-control study

Matthias Mehdorn et al. Int J Colorectal Dis. 2021 Sep.

Erratum in

Abstract

Purpose: Infectious complications are as high as 30% in elective colorectal surgery. In recent years, several studies have discussed the topic of preoperative bowel decontamination prior to colorectal surgery in order to reduce postoperative infectious complications and have found significant effects of oral antibiotic administration with a large variety of drugs used. No study has evaluated the combination of oral paromomycin and metronidazole in this context.

Methods: We performed a prospective single-center study with a matched-pair retrospective cohort to evaluate postoperative infectious complications (superficial site infections, organ space abscess, anastomotic leakage) in elective colorectal surgery.

Patients: A total of 120 patients were available for study inclusion; 101 gave informed consent and were included. A total of 92 patients were matched and subsequently analyzed. We could show a reduction in overall infectious complications in the intervention group (15.2% vs 30.8%, p = 0.018; odds ratio 0.333, 95% CI 0.142-0.784) as well as a reduction in superficial surgical site infections (8.7 vs 19.6%, p = 0.041, OR 0.333, 95% CI 0.121-0.917). The frequency of the other infectious complications such as intraabdominal abscesses and anastomotic leakage showed a tendency towards decreased frequencies in the intervention group (OR 0.714, 95% CI 0.235-2.169 and OR 0.571; 95% CI 0.167-1.952, respectively). Finally, the oral antibiotic administration led to an almost significantly reduced length of stay (12.24 days vs 15.25 days; p = 0.057).

Conclusions: Oral paromomycin and metronidazole with intravenous ertapenem effectively reduce infectious complications in elective colorectal surgery.

Trial registration: The study was registered at Clinicaltrials.gov (NCT03759886) December 17, 2018.

Keywords: Antibiotic bowel preparation; Colorectal resections; Mechanic bowel preparation; Paromomycin; Surgical site infections.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The selection process
Fig. 2
Fig. 2
Number of SSI per 100 indicator procedures
See this image and copyright information in PMC

References

    1. Anjum N, Ren J, Wang G, Li G, Wu X, Dong H, Wu Q, Li J. A randomized control trial of preoperative oral antibiotics as adjunct therapy to systemic antibiotics for preventing surgical site infection in clean contaminated, contaminated, and dirty type of colorectal surgeries. Dis Colon Rectum. 2017;60(12):1291–1298. doi: 10.1097/dcr.0000000000000927. - DOI - PubMed
    1. Roos D, Dijksman LM, Oudemans-van Straaten HM, de Wit LT, Gouma DJ, Gerhards MF. Randomized clinical trial of perioperative selective decontamination of the digestive tract versus placebo in elective gastrointestinal surgery. Br J Surg. 2011;98(10):1365–1372. doi: 10.1002/bjs.7631. - DOI - PubMed
    1. McChesney SL, Zelhart MD, Green RL, Nichols RL. Current U.S. pre-operative bowel preparation trends: a 2018 survey of the American Society of Colon and Rectal Surgeons Members. Surg Infect. 2020;21(1):1–8. doi: 10.1089/sur.2019.125. - DOI - PubMed
    1. Eskicioglu C, Forbes SS, Fenech DS, McLeod RS. Preoperative bowel preparation for patients undergoing elective colorectal surgery: a clinical practice guideline endorsed by the Canadian Society of Colon and Rectal Surgeons. Can J Surg. 2010;53(6):385–395. - PMC - PubMed
    1. Kiran RP, Murray ACA, Chiuzan C, Estrada D, Forde K. Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery. Ann Surg. 2015;262(3):416–425. doi: 10.1097/sla.0000000000001416. - DOI - PubMed

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