Association of antimicrobial perioperative prophylaxis with cefuroxime plus metronidazole or amoxicillin/clavulanic acid and surgical site infections in colorectal surgery
Abstract 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 recomm...
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | Antimicrobial Resistance and Infection Control |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13756-023-01307-y |
| _version_ | 1797556388179738624 |
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| author | Elisavet Stavropoulou Andrew Atkinson Marie-Christine Eisenring Christoph A. Fux Jonas Marschall Laurence Senn Nicolas Troillet |
| author_facet | Elisavet Stavropoulou Andrew Atkinson Marie-Christine Eisenring Christoph A. Fux Jonas Marschall Laurence Senn Nicolas Troillet |
| author_sort | Elisavet Stavropoulou |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-03-10T17:01:09Z |
| format | Article |
| id | doaj.art-ae9f37dc04bb46ca844363effb5ece77 |
| institution | Directory Open Access Journal |
| issn | 2047-2994 |
| language | English |
| last_indexed | 2024-03-10T17:01:09Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Antimicrobial Resistance and Infection Control |
| spelling | doaj.art-ae9f37dc04bb46ca844363effb5ece772023-11-20T10:57:41ZengBMCAntimicrobial Resistance and Infection Control2047-29942023-09-011211710.1186/s13756-023-01307-yAssociation of antimicrobial perioperative prophylaxis with cefuroxime plus metronidazole or amoxicillin/clavulanic acid and surgical site infections in colorectal surgeryElisavet Stavropoulou0Andrew Atkinson1Marie-Christine Eisenring2Christoph A. Fux3Jonas Marschall4Laurence Senn5Nicolas Troillet6Service of Infectious Diseases, Central Institute, Valais HospitalDepartment of Infectious Diseases, Bern University Hospital, Inselspital, University of BernService of Infectious Diseases, Central Institute, Valais HospitalDivision of Infectious Diseases and Infection Prevention, Kantonsspital AarauDepartment of Infectious Diseases, Bern University Hospital, Inselspital, University of BernSwissnoso, National Center for Infection PreventionService of Infectious Diseases, Central Institute, Valais HospitalAbstract 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.https://doi.org/10.1186/s13756-023-01307-ySurgical site infectionAntibiotic prophylaxisColorectal surgeryAmoxicillin/clavulanic acidCefuroximeMetronidazole |
| spellingShingle | Elisavet Stavropoulou Andrew Atkinson Marie-Christine Eisenring Christoph A. Fux Jonas Marschall Laurence Senn Nicolas Troillet 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 Surgical site infection Antibiotic prophylaxis Colorectal surgery Amoxicillin/clavulanic acid Cefuroxime Metronidazole |
| title | Association of antimicrobial perioperative prophylaxis with cefuroxime plus metronidazole or amoxicillin/clavulanic acid and surgical site infections in colorectal surgery |
| title_full | Association of antimicrobial perioperative prophylaxis with cefuroxime plus metronidazole or amoxicillin/clavulanic acid and surgical site infections in colorectal surgery |
| title_fullStr | Association of antimicrobial perioperative prophylaxis with cefuroxime plus metronidazole or amoxicillin/clavulanic acid and surgical site infections in colorectal surgery |
| title_full_unstemmed | Association of antimicrobial perioperative prophylaxis with cefuroxime plus metronidazole or amoxicillin/clavulanic acid and surgical site infections in colorectal surgery |
| title_short | Association of antimicrobial perioperative prophylaxis with cefuroxime plus metronidazole or amoxicillin/clavulanic acid and surgical site infections in colorectal surgery |
| title_sort | association of antimicrobial perioperative prophylaxis with cefuroxime plus metronidazole or amoxicillin clavulanic acid and surgical site infections in colorectal surgery |
| topic | Surgical site infection Antibiotic prophylaxis Colorectal surgery Amoxicillin/clavulanic acid Cefuroxime Metronidazole |
| url | https://doi.org/10.1186/s13756-023-01307-y |
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