口服抗生素可降低结直肠切除术后感染风险

根据对9,000多例患者数据的分析，在结直肠切除术前给予口服抗生素与手术部位感染率显著降低相关。

阿拉巴马大学的Jamie A. Cannon博士在美国结直肠外科医师协会(ASCRS)年会上指出，手术部位感染(SSI)至今仍是结直肠癌切除术的一个重要问题。为了评估口服抗生素作为一种手术准备措施的价值，Cannon博士及其同事回顾分析了VASQIP(退伍军人事务部手术质量改进计划)中在2005~2009年间接受结直肠切除的9,940例患者的资料。

在校正多个变量后，研究人员发现，在机械性肠道准备时口服抗生素的患者，SSI风险降低了57%。

总共有1,978例患者在结直肠切除术前并未进行肠道准备(未准备组)，3,839例患者仅接受了机械性肠道准备(机械准备组)，723例患者仅口服抗生素(口腔准备组)，3,400例患者同时行机械性肠道准备和口服抗生素(机械+口腔准备组)。结果显示，机械+口腔准备组的SSI发生率为9%，与口腔准备组相似(8%)，显著低于未准备组(18%)和机械准备组(20%)。及时给予适量的肠外抗生素(SCIP-1，VASQIP中的第一项指标)与SSI风险轻度降低相关，而其他SCIP指标似乎对SSI风险没有显著影响。

研究者承认，由于这是一项回顾性研究，因此无法了解真实的给药时间。但他们认为上述研究结果仍能有力地表明，在择期结直肠切除术前应口服抗生素。

“术前的疗效口服抗生素减少外科手术部位感染，或无机械制备，应作进一步研究在随机试验中，他们的结论。

Cannon博士无利益冲突披露。

爱思唯尔  版权所有

By: HEIDI SPLETE, Internal Medicine News Digital Network

The administration of oral antibiotics prior to elective colorectal resections is associated with significantly reduced infection rates, based on data from more than 9,000 patients.

Surgical-site infection remains a problem in colorectal resections, said Dr. Jamie A. Cannon of the department of surgery at the University of Alabama at Birmingham. To assess the value of oral antibiotics as part of the surgery preparation, Dr. Cannon and colleagues reviewed data from 9,940 patients from VASQIP (Veterans’ Affairs Surgical Quality Improvement Program) who underwent colorectal resections between 2005 and 2009. The findings were presented at the annual meeting of the American Society of Colon and Rectal Surgeons.

After controlling for multiple variables, the researchers found that patients who had an oral antibiotic along with their mechanical bowel prep had a 57% reduction in risk of surgical-site infection.

A total of 1,978 patients had no bowel prep prior to their colorectal resections, 3,839 had mechanical prep only, 723 had only oral antibiotics, and 3,400 had mechanical and oral prep. The rate of surgical-site infections in the oral and mechanical prep group was 9%, which was similar to the rate of those who only received oral antibiotics (8%), and significantly lower than the rates of both the no-prep (18%) and mechanical prep–only (20%) groups.

The timely administration of an appropriate parenteral antibiotic (SCIP-1, the first measure in the Surgical Care Improvement Project) was associated with a modest risk reduction, but no notable effects were seen from other SCIP measures, the researchers said.

They noted that decisions about the use of oral antibiotics and mechanical bowel prep were based on retrospective prescription data, and they could not determine the timing of actual administration. However, they believed that their results strongly suggest that preoperative oral antibiotics should be administered for elective colorectal resections.

"The efficacy of preoperative oral antibiotics in reducing surgical site infections, with or without a mechanical preparation, should be further studied in a randomized trial," they concluded.

Dr. Cannon had no financial conflicts to disclose.