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Comparative Study
. 2025 Feb;27(2):e70008.
doi: 10.1111/codi.70008.

Oral antibiotic prophylaxis induces changes in the microbiology of surgical site infection after colorectal surgery. A matched comparative study

Miriam Flores-Yelamos  1   2 , Montserrat Juvany  3 , Josep M Badia  1   2 , Ana Vázquez  4 , Marta Pascual  3 , David Parés  5   6 , Alexander Almendral  7 , Enric Limón  7   8   9 , Miquel Pujol  7   9   10 , Aina Gomila-Grange  11 ; Members of the VINCat Colorectal Surveillance Team
Collaborators, Affiliations
Comparative Study

Oral antibiotic prophylaxis induces changes in the microbiology of surgical site infection after colorectal surgery. A matched comparative study

Miriam Flores-Yelamos et al. Colorectal Dis. 2025 Feb.

Abstract

Aim: Oral antibiotic prophylaxis (OAP) lowers rates of surgical site infection (SSI) and may aid anastomotic healing in colorectal surgery. The aim of this study was to analyse the understudied impact of OAP on SSI microbiology after colorectal surgery.

Method: A post hoc analysis was performed on a previous prospective, multicentre study of elective colorectal surgery. For 1000 patients with SSI, this study compared the microbiology of SSIs in procedures without OAP (SSI/OAP-) and with OAP (SSI/OAP+).

Results: There were 340 patients in the SSI/OAP- group and 660 in the SSI/OAP+ group. The use of OAP increased the presence of Gram-positive cocci (GPC) (OR 1.542, 95% CI 1.153-2.062) and fungi (OR 2.037, 95% CI 1.206-3.440), but reduced rates of Gram-negative bacteria (GNB) (OR 1.461, 95% CI 1.022-2.088) and anaerobe isolation (OR 0.331, 95% CI 0.158-0.696). Specifically, it led to increases in the isolation of Enterococcus faecium (OR 1.450, 95% CI 0.812-2.591), methicillin-resistant Staphylococcus aureus (OR 2.000, 95% CI 1.043-3.834) and Candida spp. (OR 2.037, 95% CI 1.206-3.440). In colon surgery with OAP, GPC infections were more likely (OR 1.461, 95% CI 1.022-2.088). In rectal surgery, organ/space SSIs had a higher risk of harbouring GPC (OR 1.860, 95% CI 1.153-2.999) and a lower risk of GNB (OR 0.321, 95% CI 0.200-0.515).

Conclusion: OAP reduced the presence of anaerobes and GNB in SSIs, but increased the isolation of GPCs and fungi, with E. faecium and Candida being of particular concern. This information should guide empirical antibiotic therapy for postoperative colorectal SSIs in patients who have received preoperative OAP.

Keywords: adverse effects; cohort studies; colorectal surgery; microbiology; surgical site infection; surgical wound infection/prevention and control.

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Conflict of interest statement

All authors declare no conflict of interest relevant to this article. All authors submitted the ICMJE form for disclosure of potential conflicts of interest, and the conflicts that the editors consider relevant to this work are disclosed here.

Figures

FIGURE 1
FIGURE 1
Flow chart of the origin of the study patient cohort. The present investigation was a post hoc analysis of data from a cohort study investigating the efficacy of two preventive surgical site infection (SSI) bundles in elective colorectal surgery (2016–2022). Data were obtained for the period of the bundles, from which patients with SSI were identified. From these, cases for which microbiological and oral antibiotic prophylaxis (OAP) administration data were available were selected.
See this image and copyright information in PMC

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