Comparative study of ceftriaxone versus cefazolin plus clindamycin as antibiotic prophylaxis in elective colorectal surgery.
General Surgical Unit, S. Vito al Tagliamento Civic Hospital, Pordenone, Italy. firstname.lastname@example.org
A comparative study of 103 consecutive patients who required antibiotic prophylaxis for elective colorectal surgery was carried out. All eligible patients received either ceftriaxone (2 g) as a single intravenous dose at anesthetic induction or cefazolin (1 g) plus clindamycin (0.6g) administered intravenously at anesthetic induction and for two more doses at 8-hourly intervals for a total of 3 days. The incidence of postoperative wound infections was 6.9% in the ceftriaxone group and 11.1% in the cefazolin plus clindamycin group. Single-dose ceftriaxone proved to be a safe and cost-effective form of antibiotic prophylaxis for elective colorectal surgery.
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Minerva Chir. ;49 (1-2):55-8 8208468
Divisione di Chirurgia Generale, Ospedale Civile S. Maria dei Battuti, USL n. 9 del Sanvitese, S. Vito al Tagliamento, Pordenone.
The purpose of this investigation was to examine the safety and efficacy of cefoxitin in preoperative prophylaxis of acute nonperforated, appendicitis. During twelve consecutive months, a single i.v. dose of cefoxitin was administered to 151 patients suffering from nonperforated appendicitis. The study confirms the preoperative prophylaxis with cefoxitin used regularly with patients who are undergoing an appendicectomy.
Divisione Chirurgia Generale, Ospedale Civile S. Maria dei Battuti, USL n. 9 del Sanvitese, S. Vito al Tagliamento, Pordenone.
For the radical surgical treatment of pilonidal cysts and fistulas, the authors suggest the excision "en bloc" of the complete pathological tissue and the primary closure, according to a procedure which considers not only a accurate surgical technique and a kind of dressing which avoids pressure and traction on the sutures, but also a s.t. antibiotic prophylaxis based on culture tests. This kind of approach in surgical treatment showed according to their experience, excellent immediate and long term results, causing slight inconvenience to patients, with a short recovery with regard to cases treated without primary closure.
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Elie Aoun, Sandra El Hachem, Heitham Abdul-Baki, Bassem Ayyach, Mohamad Khalifeh, Hani Chaar, Zeina A Kanafani, Souha S Kanj, Ala I Sharara
Department of Internal Medicine, American University of Beirut Medical Center, Lebanon.
BACKGROUND The role of antibiotic prophylaxis in preventing post-operative complications in patients undergoing elective colorectal surgery is well established. Despite evidence that a single-dose prophylaxis is sufficient, the duration of antibiotic use in clinical practice is highly variable and surveys have identified persistent patterns of antibiotic abuse in elective colorectal surgery. MATERIALS AND METHODS We conducted a retrospective review of all patients who underwent elective colorectal surgery between 1998 and 2002 at the American University of Beirut Medical Center. A survey among general surgeons in Lebanon was also performed to investigate the pattern of antibiotic prophylaxis used in such cases. The MEDLINE database (1966-2004) was searched for English-language articles and abstracts on antimicrobial use in elective colorectal surgery. Papers cited in relevant primary articles were also reviewed. Data were extracted and reviewed by all authors. RESULTS Two hundred and eleven matching patient-records were identified. A triple regimen including metronidazole, ampicillin and an aminoglycoside was the most commonly used preoperative prophylactic method. Patients received post-operative antibiotics for a mean of 6.66+/-2.62 days. The mean duration of post-operative antibiotic prophylaxis used by the interviewed surgeons was 4.31+/-1.08 days. CONCLUSIONS Our study confirms that even when strong evidence exists, surgeons fail to adhere to antibiotic prophylaxis guidelines. This pattern is not unique to Lebanon but is shared to a large extent by surgeons around the world. Adherence to published guidelines and improved education of surgeons are essential to the delivery of cost-effective medical practice.
Clin Nutr. 1983 Mar ;1 (4):289-95 16829393
Department of Surgery, Northern General Hospital, Sheffield, U.K.
The nutritional status of 65 patients undergoing elective colorectal surgery was assessed using 5 conventional nutritional indices, percentage ideal weight, mid arm muscle circumference, triceps skin fold thickness, serum albumin and serum total iron binding capacity. Only 9 patients had values for all five indices which are taken to represent normal nutritional status. This survey suggests that many patients undergoing elective colorectal surgery in this country have subnormal values of the indices commonly used for nutritional assessment but only severe depression of serum albumin however appears to adversely affect the outcome of surgery.
University of Gezira, Wad Medani, Sudan.
We carried out a prospective, randomized, controlled clinical trial to evaluate the clinical efficacy of ceftriaxone and ampicillin/cloxacillin prophylaxis in decreasing the frequency of post-caesarean section infection-related morbidity. Two hundred patients randomly received either ceftriaxone (single dose) or ampicillin/cloxacillin (3 doses) intravenously at induction of anaesthesia. There was no statistical difference in incidence of endometritis (P = 0.34), wound infection (P = 0.44), or other febrile morbidity (P = 0.5). Eleven babies had a low Apgar score (< 8) in the ceftriaxone group and 13 in the ampicillin/cloxacillin group (P = 0.82). There were 2 perinatal deaths in each group. One dose of ceftriaxone was as effective as ampicillin/ cloxacillin in preventing post-caesarean section complications and is easier to administer.
Francesca Rovera, Mario Diurni, Gianlorenzo Dionigi, Luigi Boni, Alberta Ferrari, Giulio Carcano, Renzo Dionigi
Department of Surgical Sciences, University of Insubria, Azienda Ospedaliero-Universitaria, Fondazione Macchi, Varese, Italy. email@example.com
Nosocomial infections are the most frequent complications observed in surgical patients. In colorectal surgery, the opening of the viscera causes the dissemination into the operative field of microorganisms originating from endogenous sources, increasing the chance of developing postoperative complications. It is reported that without antibiotic prophylaxis, wound infection after colorectal surgery develops in approximately 40% of patients. This percentage decreases to approximately 11% after antibiotic prophylaxis. Specific criteria in the choice of correct antibiotic prophylaxis have to be respected, on the basis of the microorganisms usually found in the surgical site, and on the specific hospital microbiologic epidemiology.
Prospective, randomised study on antibiotic prophylaxis in colorectal surgery. Is it really necessary to use oral antibiotics?
Eloy Espin-Basany, Jose Luis Sanchez-Garcia, Manuel Lopez-Cano, Roberto Lozoya-Trujillo, Meritxell Medarde-Ferrer, Lluis Armadans-Gil, Laia Alemany-Vilches, Manuel Armengol-Carrasco
Department of General Surgery, Colorectal Surgery Unit, Hospital Valle de Hebron, Autonomous University of Barcelona, 4th Floor, Pg Valle de Hebron 119-129, Barcelona, 08035, Spain. firstname.lastname@example.org
BACKGROUND AND AIMS The use of prophylactic antibiotics in addition to mechanical cleansing is the current standard of care prior to colonic surgery. The question of whether the antibiotics should be administered intravenously or orally, or by both routes, remains controversial. Our aim was to compare three methods of prophylactic antibiotic administration in elective colorectal surgery. METHODS Three hundred consecutive elective colorectal resections were studied. All patients had preoperative mechanical colon cleansing with oral sodium phosphate and intravenous antibiotic prophylaxis with cefoxitin (one dose before skin incision and two postoperative doses). Patients were randomised to one of the following three groups: group A: three doses of oral antibiotic (neomycin and metronidazole) at the time of mechanical colon cleansing; group B: one dose of oral antibiotic; group C: no oral antibiotics. All patients were followed during their hospital stay and at 7, 14 and 30 days post-surgery. RESULTS Vomiting occurred in 31%, 11% and 9% of the studied patients (groups A, B and C, respectively)(p<0.001). Nausea was present in 44%, 18% and 13% of patients (p<0.001). Abdominal pain was recorded in 13%, 10% and 4% of patients (p: 0.077). Wound infection was present in 7%, 8% and 6% and suture dehiscence occurred in 2%, 2% and 3% of the patients in the three groups (no differences among them). Neither were differences found among the three groups in terms of urinary infections, pneumonia, postoperative ileus or intra-abdominal abscess. CONCLUSION The addition of three doses of oral antibiotics to intravenous antibiotic prophylaxis is associated with lower patient tolerance in terms of increased nausea, vomiting and abdominal pain, and has shown no advantages in the prevention of postoperative septic complications. Therefore, we recommend that oral antibiotics should not be used prior to colorectal surgery.
Department of Infectious Diseases and Tropical Medicine, San Bortolo Hospital, Vicenza, Italy. email@example.com
PURPOSE Infections after maxillofacial surgery are usually due to aerobic and anaerobic gram-positive cocci and gram-negative bacilli. Various antimicrobials, including cephalosporins, beta-lactams/beta-lactamase inhibitors, aminoglycosides, lincosamides, and fluoroquinolones, have been tested for use for perioperative prophylaxis in maxillofacial surgery. However, the best regimen has not been determined. We tested the safety and the efficacy of clindamycin plus cefazolin as perioperative prophylaxis for patients undergoing major maxillofacial procedures. PATIENTS AND METHODS Intravenous cefazolin and clindamycin in 3 doses were administered to 155 patients undergoing major maxillofacial procedures. After surgery, patients were monitored for the presence of infection and side effects. RESULTS No patient experienced a fever or infection after surgery. No side effects related to these antibiotics were observed. CONCLUSIONS The antibiotics used as prophylaxis in maxillofacial surgery should possess an adequate coverage against gram-positive aerobic and anaerobic cocci as well as gram-negative bacilli. Prophylaxis with cefazolin plus clindamycin in major maxillofacial seems safe and effective.
Department of Surgery, University of California, Irvine Medical Center, Orange, California 92868, USA.
BACKGROUND Influenced by the key results of the clinical trials conducted in the early 1970s by Condon, Nichols, and Gorbach, surgeons have adopted the routine use of mechanical bowel prep and antimicrobial prophylaxis prior to elective colorectal procedures as a widely established practice. Recent clinical trial data, however, led us to reexamine the benefits of mechanical bowel preparation, methods of antimicrobial prophylaxis and to assess the role of new, specific risk factors for surgical site infection after colorectal operations. METHODS Pertinent studies on antimicrobial prophylaxis for elective colorectal surgery were identified from a Medline search of English language publications since 1966. RESULTS We found credible clinical trial data that mechanical bowel preparation prior to elective colorectal surgery may not be essential. Timing of the administration of prophylactic antimicrobials is often inaccurate in current practice and suggests the need for a long-acting, broad-spectrum agent that would deemphasize precision in time of preoperative infusion. New risk factors have been identified that increase infection after colorectal surgery, including patient core temperature and tissue oxygenation. Independent observers identify postoperative surgical site infection at a higher rate than physician self-reporting and should be incorporated into future clinical trials. CONCLUSION The once settled area of antimicrobial prophylaxis for colorectal surgery is again controversial. Cooperative clinical trials will be needed to resolve key questions such as the efficacy for bowel preparation and how to obtain effective timing of antimicrobial prophylaxis.
Rev Assoc Med Bras. ;49 (2):214-9 12886403
[Prophylactic routine anastomotic drainage in elective colorectal surgery: systematic review and metanalysis]
Departamento de Cirurgia, Centro Cochrane do Brasil, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
OBJECTIVE: To analyse the results of the comparison of the use or not of routine prophylactic drainage of anastomoses after elective colorectal surgery. The following hypothesis will be tested: the use of routine prophylactic drainage of anastomoses after elective colorectal surgery is unjustified.
Department of General Surgery and Coloproctology, Medical University, 15A Vassil Aprilov St., 4000 Plovdiv, Bulgaria.
BACKGROUND Antibiotic prophylaxis has greatly reduced the rate of postoperative infectious complications since its utilization in the elective colorectal surgery in the last several decades. Although the need of its application is indisputable, the optimal duration of antibiotic prophylaxis is still on debate. AIM The aim of the present study was to compare two regimens of antibiotic prophylaxis with different duration. MATERIALS AND METHODS A retrospective clinical study was conducted of 190 patients that underwent elective surgery for colorectal carcinoma in the Clinic between January 1997 and June 2000. The patients were divided into two groups according to the regimen of antibiotic prophylaxis. Group 1 (n = 92) patients received a 24-hour antibiotic prophylaxis and Group 2 (n = 98) had a prolonged antibiotic cover that lasted 5 days. The antibiotic prophylaxis was conducted with a third generation cefalosporin and metronidazole. RESULTS Of all 190 patients 92 were in Group 1 and 98 in Group 2. Postoperative infectious wound complications were found in 14 (15.2%) patients from Group 1 and in 25 (25.5%) patients from Group 2. The difference did not reach statistical significance (P > 0.05). CONCLUSION The results of the study show no advantage of the prolonged over short-term antibiotic prophylaxis. Based on the study findings the authors suggest that a 24-hour antibiotic prophylaxis should be recommended for the lower rate of side effects and lower cost.