Results of selective decontamination with oral neomycin and metronidazole for major colorectal surgery in Australia:A cohort study  

作　　者：James Wei Tatt Toh Devansh Shah Henry Wang Charlotte Kwik Joseph Do Woong Choi Chelsie Leonie Beinke Paul Morris Eleni Baird-Gunning Geoffrey Peter Collins Fiona Gavegan Karen Shedden Toufic El-Khoury Nimalan Pathma-Nathan Kerry Hitos 

机构地区：[1]Department of Colorectal Surgery,Westmead Hospital,Westmead,New South Wales,Australia [2]The University of Sydney,Westmead Hospital,Westmead,New South Wales,Australia [3]Western Sydney University,New South Wales,Australia [4]University of Notre Dame,New South Wales,Australia [5]Westmead Research Centre for Evaluation of Surgical Outcomes,Westmead Hospital,Sydney,Australia

出　　处：《Laparoscopic, Endoscopic and Robotic Surgery》2024年第2期72-78,共7页腔镜、内镜与机器人外科（英文）

摘　　要：Objective The role of selective decontamination with oral antibiotics(OABs)and mechanical bowel preparation(MBP)prior to elective colorectal surgery is still widely debated.The objective of this study was to compare the outcomes of selective decontamination with neomycin,metronidazole and MBP compared to those of decontamination with MBP alone or with no preparation.Methods Selective decontamination with neomycin and metronidazole combined with bowel preparation was introduced prior to elective colorectal surgery as part of an enhanced recovery after surgery program at Westmead Hospital,a major Australian tertiary referral hospital,between June 2017 and January 2023.Comparisons between short-term outcomes of OAB+MBP and MBP/no preparation were made using prospectively collected data on length of stay(LOS),readmission,mortality within 30 days,anastomotic leakage(AL),surgical site infection(SSI),urinary tract infection,deep venous thrombosis and/or pulmonary embolism,pneumonia,and ileus.Follow-up was limited to hospital stays and subsequent presentations within the health district within thirty days of surgery.The Mann-Whitney U test was used to analyse continuous data,and the chi-square test was used for categorical data.Univariate and multivariate regression modelling was performed to identify risk factors associated with an increased likelihood of SSI and AL.Results Patients with oral neomycin and metronidazole combined with bowel preparation had reduced superficial SSI(2.7%vs.7.6%,p=0.043)and overall complications(32.7%vs.44.6%,p=0.020),particularly Clavien-Dindo 1 complications(7.3%vs.16.5%,p=0.009).However,the differences in AL(2.7%vs.4.5%,p=0.369)and organ/space SSI(1.3%vs.3.7%,p=0.327)were not statistically significant.The median LOS(6 d vs.6 d,p=0.370)was not different between the groups.Conclusion Selective decontamination with neomycin and metronidazole reduces the risk of SSIs and overall complications.There was a trend to toward a lower AL,but this difference was not statistically significant.

关 键 词：NEOMYCIN METRONIDAZOLE Colorectal surgery Anastomotic leakage Surgical site infection 

分 类 号：R735.34[医药卫生—肿瘤]