Reduction in deep organ-space infection in gynecologic oncology surgery with use of oral antibiotic bowel preparation: a retrospective cohort analysis.

IF 1.4 Q2 MEDICINE, GENERAL & INTERNAL Journal of Osteopathic Medicine Pub Date : 2024-10-09 DOI:10.1515/jom-2024-0099
Kathryn Kennedy, Jennifer Gaertner-Otto, Eav Lim
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引用次数: 0

Abstract

Context: Deep organ-space infection (OSI) following gynecologic surgery is a source of patient morbidity and mortality. There is currently conflicting evidence regarding the use of bowel preparation prior to gynecologic surgery to reduce the rates of infection. For the additional purpose of improving patient recovery at our own institution, a retrospective cohort study compared the rate of deep OSI in patients who received oral antibiotic bowel preparation per Nichols-Condon bowel preparation with metronidazole and neomycin.

Objectives: The primary aim of this study was to compare the rate of deep organ-space surgical site infection in gynecologic surgery before and after institution of an oral antibiotic bowel preparation, thus assessing whether the preparation is associated with decreased infection rate. The secondary objective was to identify other factors associated with deep organ-space site infection.

Methods: A retrospective cohort study was performed. Demographic and surgical data were collected via chart review of 1,017 intra-abdominal surgeries performed by gynecologic oncologists at a single institution from April 1, 2019 to December 1, 2021. Of these, 778 met the inclusion criteria; 444 did not receive preoperative oral antibiotic bowel preparation, and 334 did receive preoperative bowel preparation. Odds ratios (ORs) were calculated, and a logistic regression model was utilized for categorical variables. Multivariable regression analysis was performed.

Results: A total of 778 patients were included. Deep OSI rate in patients who did not receive oral antibiotic bowel preparation was 2.3 % compared to 0.3 % (OR 0.13, confidence interval [CI] 0.06-1.03, p=0.02) in patients who did. Receiving oral antibiotic bowel preparation predicted absence of deep OSI (OR 0.04, CI 0.00-0.87, p=0.04). Laparotomy (OR 20.1, CI 1.6-250.2, p=0.02) and Asian race (OR 60.8, CI 2.6-1,380.5, p=0.01) were related to increased rates of deep OSI.

Conclusions: Oral antibiotic bowel preparation predicts a reduced risk of deep OSI. This preparation is inexpensive and low-risk, and thus these clinically significant results support a promising regimen to improve surgical outcomes, and provide guidance for prospective larger studies.

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使用口服抗生素肠道制剂减少妇科肿瘤手术中的深部器官间隙感染:一项回顾性队列分析。
背景:妇科手术后的深部器官间隙感染(OSI)是导致患者发病和死亡的原因之一。目前,关于在妇科手术前使用肠道准备以降低感染率的证据并不一致。为了改善患者的恢复情况,本机构还进行了一项回顾性队列研究,比较了接受口服抗生素肠道准备和使用甲硝唑和新霉素进行尼可康肠道准备的患者的深部 OSI 发生率:本研究的主要目的是比较妇科手术中口服抗生素肠道准备前后的深部器官间隙手术部位感染率,从而评估该准备是否与感染率降低有关。次要目标是确定与深部器官间隙部位感染相关的其他因素:进行了一项回顾性队列研究。从 2019 年 4 月 1 日至 2021 年 12 月 1 日,通过病历审查收集了由一家机构的妇科肿瘤专家实施的 1,017 例腹腔内手术的人口统计学和手术数据。其中,778例符合纳入标准;444例未接受术前口服抗生素肠道准备,334例接受了术前肠道准备。计算了比值比 (OR),并对分类变量采用了逻辑回归模型。进行了多变量回归分析:结果:共纳入 778 名患者。未接受口服抗生素肠道准备的患者的深度 OSI 率为 2.3%,而接受口服抗生素肠道准备的患者的深度 OSI 率为 0.3%(OR 0.13,置信区间 [CI]0.06-1.03,P=0.02)。接受口服抗生素肠道准备的患者不会出现深部 OSI(OR 0.04,CI 0.00-0.87,P=0.04)。开腹手术(OR 20.1,CI 1.6-250.2,P=0.02)和亚洲人种(OR 60.8,CI 2.6-1,380.5,P=0.01)与深部OSI发生率增加有关:结论:口服抗生素肠道制剂可降低深部 OSI 的风险。结论:口服抗生素肠道准备可降低深部 OSI 的风险。这种准备方法成本低、风险小,因此这些具有临床意义的结果支持了一种可改善手术预后的方案,并为更大规模的前瞻性研究提供了指导。
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来源期刊
Journal of Osteopathic Medicine
Journal of Osteopathic Medicine Health Professions-Complementary and Manual Therapy
CiteScore
2.20
自引率
13.30%
发文量
118
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