Antibiotic Prophylaxis in Colorectal Surgery

Česká verzia

Authors: R. Hrivnák ¹; I. Hanke ¹; M. Hanslianová ²; Z. Kala ¹; A. Ševčíková ²
Authors place of work: Chirurgická klinika FN Brno-Bohunice, LF MU v Brně, přednosta: prof. MUDr. Zdeněk Kala, CSc. ¹; Oddělení klinické mikrobiologie FN Brno, primářka: MUDr. Alena Ševčíková ²
Published in the journal: Rozhl. Chir., 2009, roč. 88, č. 6, s. 330-333.
Category: Monotematický speciál - Původní práce

Summary

Objective:
Antibiotic (ATB) prophylaxis is generaly recommended in surgery. There is an important role in colorectal surgery especially. Colorectal surgery is associated with a particularly high risk of post-operative infection because of contamination of the wound with faecal bacteria. ATB prophylaxis decreases surgical wound infection, morbidity and mortality as well. Morbidity and mortality are associated with longer hospital stays and increased costs of care.

Method:
At surgical department of Faculty hospital Brno, during March–June 2008 an 88 patients were operated because of different diagnoses in colorectum. Both an emergent and schedule operations were made. Type of ATBs, time of aplication before operation, reaplication after operation and surgical site infection (SSI), in - hospital stay were followed up prospectively. SSI were divided into superficial, deep and intraabdominal. Data were analyse statistically.

Results:
The most used combination of ATBs, almost in 91%, were Cefazoline and Metronidazole. In 50% were time of aplication till 20 minutes before incision. Only in 17% were time of aplication in interval 20–30 minutes before incision, which is recommended. We noticed 25 SSI. We prove that patients with SSI has almost two-times longer in-hospital stay. Enterococcus and enterobacterias were the most common etiological agens.

Conclusion:
ATB prophylaxis is indicated in colorectal surgery. It has to be aplicated in correct dose and right time before operation to decrease SSI.

Key words:
antibiotic prophylaxis – surgical site infection – in-hospital stay

Zdroje

1. Plowman, R., Graves, N., Roberts, J. Hospital Acquired Infection. London: Office of Health Economics, 1997.

2. Dellinger, E., Gross, P., Barrett, T., et al. Quality standard for antimicrobial prophylaxis in surgical procedures. Clin. Infect. Dis., 1994; 18: 422–427.

3. McGowan, J. Cost and benefit of perioperative antimicrobial prophylaxis: methods for economic analysis. Rev. Infect. Dis., 1991; 13: 879–889.

4. Coello, R., Glenister, H., Fereres, J., et al. The cost of infection in surgical patients: a case control study. J. Hosp. Infect., 1993; 25: 239–250.

5. Ludwig, K., Carlson, M., Condon, R. Prophylactic antibiotics in surgery. Annu. Rev. Med., 1993; 44: 385–393.

6. Song, F., Glenny, A. Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomised controlled trials. Health Technik Assessment, 1998; 2(7).

7. Song, F., Glenny, A. Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomised controlled trials. Br. J. Surg., 1998; 85: 1232–1241.

8. Nelson, R. L., Glenny, A. M., Song, F. Antimicrobial prophylaxis for colorectal surgery. Department of General Surgery, Northern General Hospital, Herries Road, Sheffield, Yorkshire, UK, S5 7AU.

9. Weber, W. P., Marti, W. R., Zwahlen, M., Misteři, H., Rosenthal, R., Reck, S., Fueglistaler, P., Bolli, M., Trampuz, A., Oertli, D., Widmer, A. F. The timing of surgical antimicrobial prophylaxis. Department of General Surgery, University Hospital of Basel, Basel, Switzerland.

10. Ludwig, K., Carlson, M., Condon, R. Prophylactic antibiotics in surgery. Annu. Rev. Med., 1993; 44: 385–393

11. Sanderson, P. Antimicrobial prophylaxis in surgery: microbiological factors. J. Antimicrob. Chemother., 1993; 31 Suppl. B: 1–9.

12. Antibiotic prophylaxis in surgery, A National Clinical Guidelines (104), Scottish Intercollegiate Guidelines Network, July 2008

13. Gomez-Alonso, A, Lozano, F, Perez, A, et al. Systemic prophylaxis with gentamicin-metronidazole in appendicectomy and colorectal surgery: a prospective controlled clinical study. Int. Surg., 1984; 69: 17–20.

14. Gottrup, F., Diederich, P., Sorensen, K., et al. Prophylaxis with whole gut irrigation and antimicrobials in colorectal surgery. A prospective, randomized double-blind clinical trial. Am. J. Surg., 1985; 149: 317–321.

15. Schiessel, R., Huk, I., Wunderlich, M., et al. Postoperative infections in colonic surgery after enteral bacitracinneomycin-clindamycin or parenteral mezlocillin-oxacillin prophylaxis. J. Hosp. Infect., 1984; 5: 289–297.

16. Utley, R., Macbeth, W. Preoperative cefoxitin: a double-blind prospective study in the prevention of wound infections. J. R. Coll. Surg. Edinb., 1984; 29: 143–146.

17. Kolář, M. Antimikrobní profylaxe v chirurgii. Interní medicína pro praxi. 2000; 2(3): 36–37.