Results of selective decontamination with oral neomycin and metronidazole for major colorectal surgery in Australia: A cohort study

James Wei Tatt Toh; Devansh Shah; Henry Wang; Charlotte Kwik; Joseph Do Woong Choi; Chelsie Leonie Beinke; Paul Morris; Eleni Baird-Gunning; Geoffrey Peter Collins; Fiona Gavegan; Karen Shedden; Toufic El-Khoury; Nimalan Pathma-Nathan; Kerry Hitos

Laparoscopic, Endoscopic and Robotic Surgery (Jun 2024)

Results of selective decontamination with oral neomycin and metronidazole for major colorectal surgery in Australia: A cohort study

James Wei Tatt Toh,
Devansh Shah,
Henry Wang,
Charlotte Kwik,
Joseph Do Woong Choi,
Chelsie Leonie Beinke,
Paul Morris,
Eleni Baird-Gunning,
Geoffrey Peter Collins,
Fiona Gavegan,
Karen Shedden,
Toufic El-Khoury,
Nimalan Pathma-Nathan,
Kerry Hitos

Affiliations

James Wei Tatt Toh: Department of Colorectal Surgery, Westmead Hospital, Westmead, New South Wales, Australia; The University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia; Corresponding author: Department of Colorectal Surgery, Westmead Hospital, Westmead, New South Wales, Australia.
Devansh Shah: Department of Colorectal Surgery, Westmead Hospital, Westmead, New South Wales, Australia; Western Sydney University, New South Wales, Australia
Henry Wang: Department of Colorectal Surgery, Westmead Hospital, Westmead, New South Wales, Australia
Charlotte Kwik: Department of Colorectal Surgery, Westmead Hospital, Westmead, New South Wales, Australia
Joseph Do Woong Choi: Department of Colorectal Surgery, Westmead Hospital, Westmead, New South Wales, Australia; The University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia
Chelsie Leonie Beinke: Department of Colorectal Surgery, Westmead Hospital, Westmead, New South Wales, Australia
Paul Morris: Department of Colorectal Surgery, Westmead Hospital, Westmead, New South Wales, Australia
Eleni Baird-Gunning: Department of Colorectal Surgery, Westmead Hospital, Westmead, New South Wales, Australia
Geoffrey Peter Collins: Department of Colorectal Surgery, Westmead Hospital, Westmead, New South Wales, Australia; The University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia
Fiona Gavegan: Department of Colorectal Surgery, Westmead Hospital, Westmead, New South Wales, Australia
Karen Shedden: Department of Colorectal Surgery, Westmead Hospital, Westmead, New South Wales, Australia
Toufic El-Khoury: Department of Colorectal Surgery, Westmead Hospital, Westmead, New South Wales, Australia; The University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia; University of Notre Dame, New South Wales, Australia
Nimalan Pathma-Nathan: Department of Colorectal Surgery, Westmead Hospital, Westmead, New South Wales, Australia; The University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia
Kerry Hitos: The University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia; Westmead Research Centre for Evaluation of Surgical Outcomes, Westmead Hospital, Sydney, Australia

Journal volume & issue: Vol. 7, no. 2
pp. 72 – 78

Abstract

Read online

Objective: The role of selective decontamination with oral antibiotics (OABs) and mechanical bowel preparation (MBP) prior to elective colorectal surgery is still widely debated. The objective of this study was to compare the outcomes of selective decontamination with neomycin, metronidazole and MBP compared to those of decontamination with MBP alone or with no preparation. Methods: Selective decontamination with neomycin and metronidazole combined with bowel preparation was introduced prior to elective colorectal surgery as part of an enhanced recovery after surgery program at Westmead Hospital, a major Australian tertiary referral hospital, between June 2017 and January 2023. Comparisons between short-term outcomes of OAB + MBP and MBP/no preparation were made using prospectively collected data on length of stay (LOS), readmission, mortality within 30 days, anastomotic leakage (AL), surgical site infection (SSI), urinary tract infection, deep venous thrombosis and/or pulmonary embolism, pneumonia, and ileus. Follow-up was limited to hospital stays and subsequent presentations within the health district within thirty days of surgery. The Mann–Whitney U test was used to analyse continuous data, and the chi-square test was used for categorical data. Univariate and multivariate regression modelling was performed to identify risk factors associated with an increased likelihood of SSI and AL. Results: Patients with oral neomycin and metronidazole combined with bowel preparation had reduced superficial SSI (2.7% vs. 7.6%, p = 0.043) and overall complications (32.7% vs. 44.6%, p = 0.020), particularly Clavien–Dindo 1 complications (7.3% vs. 16.5%, p = 0.009). However, the differences in AL (2.7% vs. 4.5%, p = 0.369) and organ/space SSI (1.3% vs. 3.7%, p = 0.327) were not statistically significant. The median LOS (6 d vs. 6 d, p = 0.370) was not different between the groups. Conclusion: Selective decontamination with neomycin and metronidazole reduces the risk of SSIs and overall complications. There was a trend to toward a lower AL, but this difference was not statistically significant.

Published in Laparoscopic, Endoscopic and Robotic Surgery

ISSN: 2468-9009 (Online)
Publisher: KeAi Communications Co., Ltd.
Country of publisher: China
LCC subjects: Medicine: Surgery
Website: https://www.keaipublishing.com/en/journals/laparoscopic-endoscopic-and-robotic-surgery/

About the journal

Abstract

Keywords