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Prophylactice antibiotics reduces surgical site infections in ulcerative colitis

Preoperative oral antibiotics and intravenous antimicrobial prophylaxis reduce the incidence of surgical site infections in patients with ulcerative colitis undergoing IPAA, reports October's Diseases of the Colon & Rectum.

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The usefulness of preoperative oral antibiotics for the prevention of surgical site infection in elective colorectal surgery remains controversial.

Dr Tsutomu Oshima and colleagues investigated the effects of oral antimicrobial prophylaxis in addition to intravenous antimicrobial prophylaxis on patients with ulcerative colitis undergoing restorative proctocolectomy.

The team performed a randomized, nonblinded, single-center clinical trial between 2006, and 2009.

The research team randomly assigned 200 patients with ulcerative colitis, scheduled to undergo restorative proctocolectomy with IPAA with an open approach, to either Group 1 or 2.

Combined use of preoperative oral antibiotics and intravenous antimicrobial prophylaxis were given to group 1, and intravenous antimicrobial prophylaxis alone was given to group 2.

Patients in Group 1 received oral antibiotics the day before surgery, whereas those in Group 2 did not.

All patients underwent preoperative mechanical bowel preparation, and intravenous antimicrobial prophylaxis with second-generation cephalosporin was given for 24 hours.

The team's primary end point was the incidence of overall surgical site infection according to intention-to-treat analysis.

The researchers found that the incidence of overall surgical site infection was significantly lower in Group 1 than in Group 2.

In multivariate analysis, the administration of oral antibiotics, and ASA score of 3 or more were independent risk factors for surgical site infection.

Dr Oshima's team concludes, "Combined oral and intravenous antimicrobial prophylaxis in patients with ulcerative colitis undergoing restorative proctocolectomy with IPAA contributed to the prevention of surgical site infection."

Dis Colon Rectum 2013: 56(10):  1149–1155
18 October 2013

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