Article

Addition of Parenteral Cefoxitin to Regimen of Oral Antibiotics for Elective Colorectal Operations

Department of Colon and Rectal Surgery, Lahey Clinic Medical Center, Burlington, Massachusetts 01805.
Annals of Surgery (Impact Factor: 8.33). 09/1990; 212(2):209-12. DOI: 10.1097/00000658-199008000-00016
Source: PubMed

ABSTRACT

The efficacy of cefoxitin, a perioperative parenteral antibiotic, combined with mechanical bowel preparation and oral antibiotics to prevent wound infections and other septic complications in patients undergoing elective colorectal operations, was examined in a prospective randomized study. All 197 patients who completed the study received mechanical bowel preparation and oral neomycin/erythromycin base. In addition a perioperative parenteral antibiotic was given in three divided doses to 101 patients. The other 96 patients received no parenteral antibiotics. The overall incidence of intra-abdominal septic complications was 7.3% (7 of 96) in the control group (no cefoxitin) and 5% (5 of 101) in the treatment group (cefoxitin). This difference was not statistically significant. The incidence of abdominal wound infection was 14.6% in the control group and 5% in the treatment group, a statistically significant difference (p = 0.02). The addition of perioperative parenteral cefoxitin greatly reduced the incidence of wound infections in patients undergoing elective colorectal operations who had been prepared with mechanical bowel cleansing and oral antimicrobial agents.

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Available from: John Coller, Apr 25, 2015
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    • "These data led to a general acceptance of the oral antibiotic bowel preparation for elective colon surgery in the U.S. Because of the parallel evolution of both the antibiotic bowel preparation and systemic preoperative preventive antibiotics in the 1970s, there was a general acceptance for using both methods together. Randomized trials of patients receiving systemic antibiotics or a placebo when patients in both arms received the oral antibiotics demonstrated reduced SSIs for both methods being used together [47, 75, 76]. Conversely, if all patients received systemic antibiotics but were randomized to oral antibiotics versus a placebo, then results likewise demonstrated improved outcomes with using both methods (Table 5) [77–83]. "
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    ABSTRACT: Infections at the surgical site continue to occur in as many as 20% of elective colon resection cases. Methods to reduce these infections are inconsistently applied. Surgical site infection (SSI) is the result of multiple interactive variables including the inoculum of bacteria that contaminate the site, the virulence of the contaminating microbes, and the local environment at the surgical site. These variables that promote infection are potentially offset by the effectiveness of the host defense. Reduction in the inoculum of bacteria is achieved by appropriate surgical site preparation, systemic preventive antibiotics, and use of mechanical bowel preparation in conjunction with the oral antibiotic bowel preparation. Intraoperative reduction of hematoma, necrotic tissue, foreign bodies, and tissue dead space will reduce infections. Enhancement of the host may be achieved by perioperative supplemental oxygenation, maintenance of normothermia, and glycemic control. These methods require additional research to identify optimum application. Uniform application of currently understood methods and continued research into new methods to reduce microbial contamination and enhancement of host responsiveness can lead to better outcomes.
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