Association of antimicrobial perioperative prophylaxis with cefuroxime plus metronidazole or amoxicillin/clavulanic acid and surgical site infections in colorectal surgery.

Stavropoulou, Elisavet; Atkinson, Andrew; Eisenring, Marie-Christine; Fux, Christoph A; Marschall, Jonas; Senn, Laurence; Troillet, Nicolas (2023). Association of antimicrobial perioperative prophylaxis with cefuroxime plus metronidazole or amoxicillin/clavulanic acid and surgical site infections in colorectal surgery. Antimicrobial resistance and infection control, 12(1), p. 105. BioMed Central 10.1186/s13756-023-01307-y

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OBJECTIVE

To compare intravenous (IV) amoxicillin/clavulanic acid (A/CA) to IV cefuroxime plus metronidazole (C + M) for preventing surgical site infections (SSI) in colorectal surgery.

BACKGROUND

Given their spectra that include most Enterobacterales and anaerobes, C + M is commonly recommended as prophylaxis of SSI in colorectal surgery. A/CA offers good coverage of Enterobacterales and anaerobes as well, but, in contrast to C + M, it also includes Enterococcus faecalis which is also isolated from patients with SSI and could trigger anastomotic leakage.

METHODS

Data from a Swiss SSI surveillance program were used to compare SSI rates after class II (clean contaminated) colorectal surgery between patients who received C + M and those who received A/CA. We employed multivariable logistic regression to adjust for potential confounders, along with propensity score matching to adjust for group imbalance.

RESULTS

From 2009 to 2018, 27,922 patients from 127 hospitals were included. SSI was diagnosed in 3132 (11.2%): 278/1835 (15.1%) in those who received A/CA and 2854/26,087 (10.9%) in those who received C + M (p < 0.001). The crude OR for SSI in the A/CA group as compared to C + M was 1.45 [CI 95% 1.21-1.75]. The adjusted OR was 1.49 [1.24-1.78]. This finding persisted in a 1:1 propensity score matched cohort of 1835 patients pairs with an OR of 1.60 [1.28-2.00]. Other factors independently associated with SSI were an ASA score > 2, a longer duration of operation, and a reoperation for a non-infectious complication. Protective factors were female sex, older age, antibiotic prophylaxis received 60 to 30 min before surgery, elective operation, and endoscopic approach.

CONCLUSIONS

Despite its activity against enterococci, A/CA was less effective than C + M for preventing SSI, suggesting that it should not be a first choice antibiotic prophylaxis for colorectal surgery.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Atkinson, Andrew David

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2047-2994

Publisher:

BioMed Central

Language:

English

Submitter:

Pubmed Import

Date Deposited:

20 Sep 2023 12:35

Last Modified:

29 Oct 2023 02:23

Publisher DOI:

10.1186/s13756-023-01307-y

PubMed ID:

37726838

Uncontrolled Keywords:

Amoxicillin/clavulanic acid Antibiotic prophylaxis Cefuroxime Colorectal surgery Metronidazole Surgical site infection

BORIS DOI:

10.48350/186404

URI:

https://boris.unibe.ch/id/eprint/186404

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