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

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Colorectal Disease Pub Date : 2025-01-30 DOI:10.1111/codi.70008

Miriam Flores-Yelamos, Montserrat Juvany, Josep M. Badia, Ana Vázquez, Marta Pascual, David Parés, Alexander Almendral, Enric Limón, Miquel Pujol, Aina Gomila-Grange, Members of the VINCat Colorectal Surveillance Team

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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.

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口服抗生素预防引起结直肠手术后手术部位感染微生物学的变化。一个匹配的比较研究。

目的：口服抗生素预防（OAP）降低手术部位感染（SSI）的发生率，并可能有助于结直肠手术吻合口愈合。本研究的目的是分析OAP对结直肠手术后SSI微生物学的影响。方法：对先前一项前瞻性、多中心的择期结直肠手术研究进行事后分析。在1000例SSI患者中，本研究比较了无OAP （SSI/OAP-）和有OAP （SSI/OAP+）手术中SSI的微生物学。结果：SSI/OAP-组340例，SSI/OAP+组660例。OAP的使用增加了革兰氏阳性球菌（GPC）（OR 1.542, 95% CI 1.153-2.062）和真菌（OR 2.037, 95% CI 1.206-3.440）的存在，但降低了革兰氏阴性菌（GNB）（OR 1.461, 95% CI 1.022-2.088）和厌氧菌的分离率（OR 0.331, 95% CI 0.158-0.696）。具体来说，它导致粪肠球菌（OR 1.450, 95% CI 0.812-2.591）、耐甲氧西林金黄色葡萄球菌（OR 2.000, 95% CI 1.043-3.834）和念珠菌（OR 2.037, 95% CI 1.206-3.440）的分离率增加。在有OAP的结肠手术中，GPC感染的可能性更大（OR 1.461, 95% CI 1.022-2.088）。在直肠手术中，器官/间隙ssi有较高的GPC风险（OR 1.860, 95% CI 1.153-2.999），而GNB风险较低（OR 0.321, 95% CI 0.200-0.515）。结论：OAP降低了ssi中厌氧菌和GNB的存在，但增加了GPCs和真菌的分离，其中粪肠杆菌和念珠菌尤其值得关注。这些信息应该指导术前接受OAP治疗的患者术后结肠直肠ssi的经验性抗生素治疗。

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.