Outcome of a 3-day vs 7-day selective digestive tract decontamination–based regimen for oral antibiotic bowel decontamination in left-sided colorectal surgery: A noninferiority study

• Published in: Journal of gastrointestinal surgery 2024-10, Vol.28 (10), p.1665-1673
• Main Authors: Wirth, Ulrich, Schardey, Josefine, von Ahnen, Thomas, Crispin, Alexander, Kappenberger, Alina, Zimmermann, Petra, Florian, Kühn, D‘Haese, Jan G., Werner, Jens, Rau, Bettina
• Format: Article
• Language: English
• Subjects: Administration, Oral; Aged; Anastomotic Leak - etiology; Anastomotic Leak - prevention & control; Anastomotic leakage; Anti-Bacterial Agents - administration & dosage; Antibiotic Prophylaxis - methods; Colorectal cancer; Colorectal Neoplasms - surgery; Decontamination - methods; Female; Humans; Male; Middle Aged; Noninferiority; Oral antibiotic bowel decontamination; Perioperative Care - methods; Retrospective Studies; Selective digestive tract decontamination; Surgical Wound Infection - prevention & control; Treatment Outcome
• ISSN: 1091-255X; 1873-4626; 1873-4626
• DOI: 10.1016/j.gassur.2024.07.031

Colorectal surgery still experiences high rates of infectious complications, such as anastomotic leakage (AL) and surgical site infections (SSIs). Therefore, oral antibiotic bowel decontamination (OABD) has experienced a renaissance. However, data on perioperative selective digestive tract decontamination (SDD)–based regimens or combined bowel preparation are inconsistent. Nonetheless, with widespread use of Enhanced Recovery After Surgery concepts, the ideal length for perioperative SDD treatment has to be reconsidered. Perioperative outcome was analyzed in a cohort of patients undergoing minimally invasive surgery for left-sided colorectal cancer in a retrospective study. Additional to usual perioperative outcome measures, including AL, SSIs, and overall infectious complications, the efficacy of a shortened 3-day perioperative OABD treatment was compared with the efficacy of a 7-day perioperative OABD treatment based on a noninferiority analysis. Overall, 256 patients were included into analysis, of whom 84 and 172 patients were treated by 3-day and 7-day perioperative OABD regimens, respectively. AL occurred in 1.2% of patients in the 3-day group and 5.2% of patients in the 7-day group, and SSIs occurred in 3.6% of patients in the 3-day group and 5.8% of patients in the 7-day group, without significant difference. The shortened 3-day perioperative SDD-based regimen was noninferior to the regular 7-day perioperative SDD-based regimen concerning the rates of AL, SSIs, and infectious complications. Our data demonstrated noninferiority of a shortened 3-day SDD-based treatment vs a 7-day SDD-based treatment for AL, SSIs, and overall infectious complications.