Citation: The Journal of Hospital Infection. 2019, 101(3), 295-299. Epub 2018 Dec 21
Author: Battersby CLF, Battersby NJ, Slade DAJ, Soop M, Walsh CJ
Abstract: Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided; colorectal resection: an international, multi-centre, prospective audit.
BACKGROUND: Increasing evidence indicates that combined mechanical and oral antibiotic bowel preparation reduces the infectious complications of colorectal surgery. Anecdotal evidence suggests the combination is rarely used in the UK & Europe.
AIM: To establish colorectal surgeons' current use, and awareness of the benefits of such bowel preparation amongst, and to identify decision-making influences surrounding preoperative bowel preparation.
METHOD: An electronic survey was emailed to all members of the Association of Coloproctology of Great Britain and Ireland, and promoted via Twitter.
FINDINGS: 495 respondents completed the survey: 413 (83.2%) UK, 39 (7.9%) other European, 43 (8.7%) non-European. Respondents used oral antibiotics for 12%-20% of cases. Mechanical bowel preparation (MBP), phosphate enema, and no preparation respectively ranged between 9%-80%. Combined MBP and oral antibiotic bowel preparation ranged between 5.5%-18.6%. 53% (260/495) agreed that combined mechanical and oral antibiotic bowel preparation reduces surgical site infection. 32% (157/495) agreed that the combination reduces risk of anastomotic leak. Kappa statistics between 0.06-0.27 indicate considerable incongruity between surgeons' awareness of the literature, and day-to-day practice. 24% (96/495) believed MBP to be incompatible with ERAS. 41% (204/495) believe that MBP delays return to normal intestinal function.
CONCLUSIONS: Few UK and European colorectal surgeons use mechanical and oral antibiotic bowel preparation, despite evidence of its efficacy in reducing infectious complications. The influence of ERAS pathways and UK and European guidelines may explain this. In contradiction to the UK and Europe, North American guidelines recommend incorporating MBP/OAB, into ERAS programmes. We suggest future UK and European guidelines incorporate MBP/OABP into the ERAS pathway.
Copyright © 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
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