Uncovering the Function of MBP and Antibiotics in Preventing Surgical Site Infections during Colorectal Procedures

Abstract

Introduction Surgical site infections (SSIs) remain a significant concern in colorectal surgery, impacting patient outcomes and healthcare costs. Mechanical bowel preparation (MBP) and antibiotic prophylaxis are widely used strategies to reduce the incidence of SSIs. However, their effectiveness and the associated risks continue to be topics of debate within the medical community. This review aims to assess the current evidence on the use of MBP and antibiotics in preventing SSIs during colorectal procedures, highlighting the benefits, controversies, and ongoing discussions in the field.

Objective This review evaluates the effectiveness and controversy surrounding the use of mechanical bowel preparation (MBP) and antibiotic prophylaxis in preventing surgical site infections (SSIs) during colorectal procedures.

Methodology The review looks at a variety of research, such as meta-analyses and trials, and examines the timing, choice of antibiotics, and various facets of MBP. Findings Prophylactic antibiotic use considerably lowers SSIs; however, resistance issues are raised. MBP works well, but there are debates over the risks involved. With continuous discussions, combined antibiotic-MBP methods are prevalent.

Conclusion the evaluation acknowledges the potential for prevention but emphasizes the need for careful use that takes patient variables into account. Optimal techniques are the subject of ongoing study, which emphasizes the dynamic nature of SSI prevention in colorectal surgery.

Keywords

mechanical bowel preparation - oral antibiotics - surgical site infections - colorectal - surgery - antibiotic resistance

Authors' Contributions

Agnes Sara Shibu and Rohit Singh Deo contributed to the writing, while Rojin G. Raj was responsible for the validation.

Publikationsverlauf

Eingereicht: 09. Mai 2024

Angenommen: 18. Juli 2024

Artikel online veröffentlicht:
04. September 2024

• References

• 1 Cima R, Dankbar E, Lovely J. et al; Colorectal Surgical Site Infection Reduction Team. Colorectal surgery surgical site infection reduction program: a national surgical quality improvement program–driven multidisciplinary single-institution experience. J Am Coll Surg 2013; 216 (01) 23-33
• 2 Xu Z, Qu H, Kanani G, Guo Z, Ren Y, Chen X. Update on risk factors of surgical site infection in colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2020; 35 (12) 2147-2156
• 3 Khan MA. et al. Clinico-Surgical Factors Affecting Surgical Site Infection in Colorectal Surgical Procedures. Int. J. Clin. Exp. Med. Res. 2018; 2 (04) 50-56
• 4 de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control 2009; 37 (05) 387-397
• 5 Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999; 20 (11) 725-730
• 6 Wick EC, Gibbs L, Indorf LA, Varma MG, Garcia-Aguilar J. Implementation of quality measures to reduce surgical site infection in colorectal patients. Dis Colon Rectum 2008; 51 (07) 1004-1009
• 7 Zywot A, Lau CSM, Stephen Fletcher H, Paul S. Bundles Prevent Surgical Site Infections After Colorectal Surgery: Meta-analysis and Systematic Review. J Gastrointest Surg 2017; 21 (11) 1915-1930
• 8 Nelson RL, Hassan M, Grant MD. Antibiotic prophylaxis in colorectal surgery: are oral, intravenous or both best and is mechanical bowel preparation necessary?. Tech Coloproctol 2020; 24 (12) 1233-1246
• 9 Kang BM, Lee KY, Park SJ, Lee S-H. Mechanical bowel preparation and prophylactic antibiotic administration in colorectal surgery: a survey of the current status in Korea. Ann Coloproctol 2013; 29 (04) 160-166
• 10 Kiran RP, Murray AC, Chiuzan C, Estrada D, Forde K. Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery. Ann Surg 2015; 262 (03) 416-425 , discussion 423–425
• 11 Koullouros M, Khan N, Aly EH. The role of oral antibiotics prophylaxis in prevention of surgical site infection in colorectal surgery. Int J Colorectal Dis 2017; 32 (01) 1-18
• 12 Castagneto-Gissey L, Russo MF, Casella-Mariolo J. et al. The Role of Antibiotic Prophylaxis in Anastomotic Leak Prevention during Elective Colorectal Surgery: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Antibiotics (Basel) 2023; 12 (02) 397
• 13 Koller SE, Bauer KW, Egleston BL. et al. Comparative effectiveness and risks of bowel preparation before elective colorectal surgery. Ann Surg 2018; 267 (04) 734-742
• 14 Rollins KE, Javanmard-Emamghissi H, Lobo DN. Impact of mechanical bowel preparation in elective colorectal surgery: A meta-analysis. World J Gastroenterol 2018; 24 (04) 519-536
• 15 Lawson EH, Hall BL, Ko CY. Risk factors for superficial vs deep/organ-space surgical site infections: implications for quality improvement initiatives. JAMA Surg 2013; 148 (09) 849-858
• 16 Nel DC. Surgical site infections. S Afr Fam Pract 2014; 56 (05) 33-37
• 17 Nichols RL, Florman S. Clinical presentations of soft-tissue infections and surgical site infections. Clin Infect Dis 2001; 33 (2, Suppl 2) S84-S93
• 18 Abbo LM, Grossi PA. AST ID Community of Practice. Surgical site infections: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33 (09) e13589
• 19 Koliarakis I, Athanasakis E, Sgantzos M. et al. Intestinal microbiota in colorectal cancer surgery. Cancers (Basel) 2020; 12 (10) 3011
• 20 Bislenghi G, Vanhaverbeke A, Fieuws S. et al. Risk factors for surgical site infection after colorectal resection: a prospective single centre study. An analysis on 287 consecutive elective and urgent procedures within an institutional quality improvement project. Acta Chir Belg 2021; 121 (02) 86-93
• 21 Wick EC, Hirose K, Shore AD. et al. Surgical site infections and cost in obese patients undergoing colorectal surgery. Arch Surg 2011; 146 (09) 1068-1072
• 22 Silvestri M, Dobrinja C, Scomersi S. et al. Modifiable and non-modifiable risk factors for surgical site infection after colorectal surgery: a single-center experience. Surg Today 2018; 48 (03) 338-345
• 23 Tanaka T, Sato T, Yamashita K, Hosoda K, Nakamura T, Watanabe M. Effect of preoperative nutritional status on surgical site infection in colorectal cancer resection. Dig Surg 2017; 34 (01) 68-77
• 24 Varela JE, Wilson SE, Nguyen NT. Laparoscopic surgery significantly reduces surgical-site infections compared with open surgery. Surg Endosc 2010; 24 (02) 270-276
• 25 Aimaq R, Akopian G, Kaufman HS. Surgical site infection rates in laparoscopic versus open colorectal surgery. Am Surg 2011; 77 (10) 1290-1294
• 26 Mik M, Berut M, Trzciński R, Dziki L, Buczynski J, Dziki A. Preoperative oral antibiotics reduce infections after colorectal cancer surgery. Langenbecks Arch Surg 2016; 401 (08) 1153-1162
• 27 S B. Voleti A, Nadiminti S, Achanta R, Perala B, Bandaru N. “Surgical Site Infections (SSIs) – The recent trends in the etiological agents and their antimicrobial resistance patterns in a teaching hospital of semi urban setup.”. Int J Med Rev Case Rep 2022;
• 28 Dadkhahfar S, Ohadi L, Biglari F, Jafari Kafiabadi M. Surgical site infection following orthopedic surgery in a patient with acne: A challenging case. Clin Case Rep 2022; 10 (12) e6700
• 29 Tanimura K, Nakajima M, Shirakawa N. et al. Surgical site infection caused by Rhizopus caespitosus after metastasectomy for osteosarcoma: First report of infection in humans. Pediatr Blood Cancer 2023; 70 (04) e30049
• 30 Upreti N, Rayamajhee B, Sherchan SP, Choudhari MK, Banjara MR. Prevalence of methicillin resistant Staphylococcus aureus, multidrug resistant and extended spectrum β-lactamase producing gram negative bacilli causing wound infections at a tertiary care hospital of Nepal. Antimicrob Resist Infect Control 2018; 7 (01) 121
• 31 Huemer M, Mairpady Shambat S, Brugger SD, Zinkernagel AS. Antibiotic resistance and persistence-Implications for human health and treatment perspectives. EMBO Rep 2020; 21 (12) e51034
• 32 Purba A. “Pharmacoeconomics of prophylactic, empirical, and diagnostic-based antibiotic treatments: Focus on surgical site infection and hospitalized community-acquired pneumonia,” 2020, Accessed: Dec. 09, 2023. [Online]. Available: https://research.rug.nl/en/publications/pharmacoeconomics-of-prophylactic-empirical-and-diagnostic-based-
• 33 Bratzler DW, Dellinger EP, Olsen KM. et al; American Society of Health-System Pharmacists (ASHP), Infectious Diseases Society of America (IDSA), Surgical Infection Society (SIS), Society for Healthcare Epidemiology of America (SHEA). Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013; 14 (01) 73-156
• 34 Peel TN, Cheng AC, Buising KL, Choong PFM. Microbiological aetiology, epidemiology, and clinical profile of prosthetic joint infections: are current antibiotic prophylaxis guidelines effective?. Antimicrob Agents Chemother 2012; 56 (05) 2386-2391
• 35 Morris MS, Graham LA, Chu DI, Cannon JA, Hawn MT. Oral antibiotic bowel preparation significantly reduces surgical site infection rates and readmission rates in elective colorectal surgery. Ann Surg 2015; 261 (06) 1034-1040
• 36 Battersby CLF, Hajibandeh S, Hajibandeh S. Oral antibiotics as adjunct to systemic antibiotics and mechanical bowel preparation for prevention of surgical site infections in colorectal surgery. Do we really need more trials?. Dis Colon Rectum 2018; 61 (06) e341-e342
• 37 Mobarki N, Almerabi B, Hattan A. Antibiotic resistance crisis. Int J Med Dev Ctries 2019; 40 (04) 561-564
• 38 Weber WP, Mujagic E, Zwahlen M. et al. Timing of surgical antimicrobial prophylaxis: a phase 3 randomised controlled trial. Lancet Infect Dis 2017; 17 (06) 605-614
• 39 Bachmann R, Leonard D, Delzenne N, Kartheuser A, Cani PD. Novel insight into the role of microbiota in colorectal surgery. Gut 2017; 66 (04) 738-749
• 40 Althumairi AA, Canner JK, Pawlik TM. et al. Benefits of bowel preparation beyond surgical site infection. Ann Surg 2016; 264 (06) 1051-1057
• 41 Lei P, Ruan Y, Yang X. et al. Preoperative mechanical bowel preparation with oral antibiotics reduces surgical site infection after elective colorectal surgery for malignancies: results of a propensity matching analysis. World J Surg Oncol 2020; 18 (01) 35
• 42 Bornstein Y, Wick EC. Bacterial Decontamination: Bowel Preparation and Chlorhexidine Bathing. Clin Colon Rectal Surg 2023; 36 (03) 201-205
• 43 Dolejs SC, Guzman MJ, Fajardo AD. et al. Bowel Preparation Is Associated with Reduced Morbidity in Elderly Patients Undergoing Elective Colectomy. J Gastrointest Surg 2017; 21 (02) 372-379
• 44 Wexner SD, Yellinek S. Is preoperative bowel preparation needed before elective colectomy?. Lancet 2019; 394 (10201): 808-810
• 45 Botha MH. Mechanical bowel preparation in gynaecological surgery–are we doing more harm than good?. S Afr Med J 2007; 97 (11) 1040-1043 , 1042–1043
• 46 Iesalnieks I, Hoene M, Bittermann T, Schlitt HJ, Hackl C. Mechanical Bowel Preparation (MBP) Prior to Elective Colorectal Resections in Crohn's Disease Patients. Inflamm Bowel Dis 2018; 24 (04) 908-915
• 47 Mulayim B, Karadag B. Do we need mechanical bowel preparation before benign gynecologic laparoscopic surgeries a randomized, single-blind, controlled trial. Gynecol Obstet Invest 2018; 83 (02) 203-208
• 48 Lee SH, Lim SW. Risk factors for postoperative delirium after colorectal surgery: a systematic review and meta-analysis. Int J Colorectal Dis 2020; 35 (03) 433-444
• 49 Tanner J, Padley W, Assadian O, Leaper D, Kiernan M, Edmiston C. Do surgical care bundles reduce the risk of surgical site infections in patients undergoing colorectal surgery? A systematic review and cohort meta-analysis of 8,515 patients. Surgery 2015; 158 (01) 66-77
• 50 Suzuki T, Sadahiro S, Tanaka A. et al. Usefulness of Preoperative Mechanical Bowel Preparation in Patients with Colon Cancer who Undergo Elective Surgery: A Prospective Randomized Trial Using Oral Antibiotics. Dig Surg 2020; 37 (03) 192-198
• 51 Gravante G, Caruso R. Mechanical bowel preparation for elective colorectal surgery: is it enough?. J Gastrointest Surg 2009; 13 (07) 1392-1394 , author reply 1395.
• 52 Rollins KE, Javanmard-Emamghissi H, Acheson AG, Lobo DN. The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery: A Meta-analysis. Ann Surg 2019; 270 (01) 43-58
• 53 Deng Y, Bao X, Ji L. et al. Resistance integrons: class 1, 2 and 3 integrons. Ann Clin Microbiol Antimicrob 2015; 14: 45
• 54 Atesok K, Papavassiliou E, Heffernan MJ. et al. Current Strategies in Prevention of Postoperative Infections in Spine Surgery. Global Spine J 2020; 10 (02) 183-194
• 55 Ng CS, Wong RH, Underwood MJ. Preventing surgical site infections: is it just too sweet?. World J Surg 2011; 35 (06) 1412-1413 , author reply 1414–1415.
• 56 Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E. et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg 2019; 55 (01) 91-115
• 57 Kulkarni N, Arulampalam T. Laparoscopic surgery reduces the incidence of surgical site infections compared to the open approach for colorectal procedures: a meta-analysis. Tech Coloproctol 2020; 24 (10) 1017-1024
• 58 Shiroky J, Lillie E, Muaddi H, Sévigny M, Choi WJ, Karanicolas PJ. The impact of negative pressure wound therapy for closed surgical incisions on surgical site infection: A systematic review and meta-analysis. Surgery 2020; 167 (06) 1001-1009
• 59 Saxer F, Widmer A, Fehr J. et al. Benefit of a single preoperative dose of antibiotics in a sub-saharan district hospital: minimal input, massive impact. Ann Surg 2009; 249 (02) 322-326
• 60 Zhang L, Liu BC, Zhang XY, Li L, Xia XJ, Guo RZ. Prevention and treatment of surgical site infection in HIV-infected patients. BMC Infect Dis 2012; 12: 115-115
• 61 Perets M, Yellinek S, Carmel O. et al. The effect of mechanical bowel preparation on postoperative complications in laparoscopic right colectomy: a retrospective propensity score matching analysis. Int J Colorectal Dis 2023; 38 (01) 133
• 62 Negussie AB, Dell AC, Davis BA, Geibel JP. Colonic Fluid and Electrolyte Transport 2022: An Update. Cells 2022; 11 (10) 1712
• 63 Tan J, Ryan ÉJ, Davey MG. et al. Mechanical bowel preparation and antibiotics in elective colorectal surgery: network meta-analysis. BJS Open 2023; 7 (03) zrad040
• 64 Petrou NA, Kontovounisios C. The Use of Mechanical Bowel Preparation and Oral Antibiotic Prophylaxis in Elective Colorectal Surgery: A Call for Change in Practice. Cancers (Basel) 2022; 14 (23) 5990
• 65 “Summary of a systematic review on mechanical bowel preparation and the use of oral antibiotics,” in Global Guidelines for the Prevention of Surgical Site Infection, World Health Organization, 2018. Accessed: Dec. 27, 2023. [Online]. Available: https://www.ncbi.nlm.nih.gov/books/NBK536423/
• 66 Woodfield JC, Clifford K, Schmidt B, Turner GA, Amer MA, McCall JL. Strategies for Antibiotic Administration for Bowel Preparation Among Patients Undergoing Elective Colorectal Surgery: A Network Meta-analysis. JAMA Surg 2022; 157 (01) 34-41
• 67 Bhat AH. et al. Mechanical bowel preparation versus no preparation in elective colorectal surgery: A prospective randomized study. Int J Surg Open 2016; 2: 26-30
• 68 Arezzo A, Mistrangelo M, Bonino MA. et al. Oral neomycin and bacitracin are effective in preventing surgical site infections in elective colorectal surgery: a multicentre, randomized, parallel, single-blinded trial (COLORAL-1). Updates Surg 2021; 73 (05) 1775-1786
• 69 Lei P-R, Liao JW, Ruan Y. et al. Risk factors analysis for surgical site infection following elective colorectal resection: a retrospective regression analysis. Chin Med J (Engl) 2020; 133 (05) 571-576
• 70 Toh JWT, Phan K, Hitos K. et al. Association of mechanical bowel preparation and oral antibiotics before elective colorectal surgery with surgical site infection: a network meta-analysis. JAMA Netw Open 2018; 1 (06) e183226-e183226
• 71 Cheng H, Chen BP-H, Soleas IM, Ferko NC, Cameron CG, Hinoul P. Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review. Surg Infect (Larchmt) 2017; 18 (06) 722-735
• 72 Yang J, Zhang X, Liang W. A retrospective analysis of factors affecting surgical site infection in orthopaedic patients. J Int Med Res 2020; 48 (04) 30 0060520907776.
• 73 Hou J, Yu C, Meng F. et al. Succession of the microbial community during the process of mechanical and biological pretreatment coupled with a bio-filter for removal of VOCs derived from domestic waste: a field study. RSC Adv 2021; 11 (63) 39924-39933
• 74 Montella E. et al. Integrated system for the proactive analisys of risk infection in patient's surgical route. Eur J Public Health 2022; 32 (03) 131-417
• 75 Berríos-Torres SI, Umscheid CA, Bratzler DW. et al; Healthcare Infection Control Practices Advisory Committee. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg 2017; 152 (08) 784-791
• 76 Schaffzin JK, Harte L, Marquette S. et al. Surgical site infection reduction by the solutions for patient safety hospital engagement network. Pediatrics 2015; 136 (05) e1353-e1360
• 77 Pineda CE, Shelton AA, Hernandez-Boussard T, Morton JM, Welton ML. Mechanical bowel preparation in intestinal surgery: a meta-analysis and review of the literature. J Gastrointest Surg 2008; 12 (11) 2037-2044
• 78 Matsou A, Vrakas G, Doulgerakis M, Hatzimisios K, Zandes N, Saliangas K. Mechanical bowel preparation before elective colorectal surgery: is it necessary?. Tech Coloproctol 2011; 15 (Suppl. 01) S59-S62
• 79 Grewal S, Reuvers JRD, Abis GSA. et al. Oral antibiotic prophylaxis reduces surgical site infection and anastomotic leakage in patients undergoing colorectal cancer surgery. Biomedicines 2021; 9 (09) 1184
• 80 Dickinson GM, Bisno AL. Antimicrobial prophylaxis of infection. Infect Dis Clin North Am 1995; 9 (03) 783-804
• 81 Enzler MJ, Berbari E, Osmon DR. “Antimicrobial prophylaxis in adults,” in Mayo Clinic Proceedings. Elsevier; 2011. 686–701. Accessed: Dec. 11, 2023. [Online]. Available: https://www.sciencedirect.com/science/article/pii/S0025619611600748
• 82 Hughes CM. Medication non-adherence in the elderly: how big is the problem?. Drugs Aging 2004; 21 (12) 793-811
• 83 Bunting J, de Klerk M. Strategies to Improve Compliance with Clinical Nursing Documentation Guidelines in the Acute Hospital Setting: A Systematic Review and Analysis. SAGE Open Nurs 2022; 8: 23 779608221075165.
• 84 Wolf Jr JS, Bennett CJ, Dmochowski RR, Hollenbeck BK, Pearle MS, Schaeffer AJ. Urologic Surgery Antimicrobial Prophylaxis Best Practice Policy Panel. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol 2008; 179 (04) 1379-1390
• 85 Brown RS, Peikes D, Peterson G, Schore J, Razafindrakoto CM. Six features of Medicare coordinated care demonstration programs that cut hospital admissions of high-risk patients. Health Aff (Millwood) 2012; 31 (06) 1156-1166
• 86 Cox JA, Vlieghe E, Mendelson M. et al. Antibiotic stewardship in low- and middle-income countries: the same but different?. Clin Microbiol Infect 2017; 23 (11) 812-818
• 87 Doernberg SB, Abbo LM, Burdette SD. et al. Essential resources and strategies for antibiotic stewardship programs in the acute care setting. Clin Infect Dis 2018; 67 (08) 1168-1174
• 88 Noba L, Rodgers S, Chandler C, Balfour A, Hariharan D, Yip VS. Enhanced Recovery After Surgery (ERAS) Reduces Hospital Costs and Improve Clinical Outcomes in Liver Surgery: a Systematic Review and Meta-Analysis. J Gastrointest Surg 2020; 24 (04) 918-932
• 89 Koch CG, Li L, Hixson E. et al. Is it time to refine? An exploration and simulation of optimal antibiotic timing in general surgery. J Am Coll Surg 2013; 217 (04) 628-635
• 90 Allebes WA, Preijers FWMB, Haanen C, Capel PJA. The development of non-responsiveness to immunotherapy with monoclonal anti-idiotypic antibodies in a patient with B-CLL. Br J Haematol 1988; 70 (03) 295-300
• 91 Koskenvuo L, Lehtonen T, Koskensalo S. et al. Mechanical and oral antibiotic bowel preparation versus no bowel preparation in right and left colectomy: subgroup analysis of MOBILE trial. BJS Open 2021; 5 (02) zrab011
• 92 Koskenvuo L, Lehtonen T, Koskensalo S. et al. Mechanical and oral antibiotic bowel preparation versus no bowel preparation for elective colectomy (MOBILE): a multicentre, randomised, parallel, single-blinded trial. Lancet 2019; 394 (10201): 840-848
• 93 Corneci D, Torsin LI, Filimon CR, Tănase NV, Moisă E, Negoita SI. Individualized surgical antibiotic prophylaxis–why, when, and how?. R J 2022; 125 (04) 561
• 94 Misteli H, Widmer AF, Rosenthal R, Oertli D, Marti WR, Weber WP. Spectrum of pathogens in surgical site infections at a Swiss university hospital. Swiss Med Wkly 2011; 140 (0304): w13146-w13146
• 95 Wells SJ, Austin M, Gottumukkala V. et al. Development of an enhanced recovery program in pediatric, adolescent, and young adult surgical oncology patients. Children (Basel) 2021; 8 (12) 1154