Prior antibiotics exposure is associated with an elevated risk of surgical site infections, including anastomotic leakage, after colon cancer but not rectal cancer surgery: A register-based study of 38,839 patients

IF 5.7 2区 医学 Q1 ONCOLOGY
Sai San Moon Lu, Martin Rutegård, Christel Häggström, Åsa Gylfe, Sophia Harlid, Bethany Van Guelpen
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Abstract

Gut microbiota composition has been implicated in surgical site complications after colorectal cancer surgery. Antibiotics affect gut microbiota, but evidence for a role in surgical site complications is inconclusive. We aimed to investigate use of prescription antibiotics during the years before surgery in relation to the risk of surgical site infections, including anastomotic leakage, within 30 days after surgery. Cardiovascular/neurological complications and the urinary antiseptic methenamine hippurate, for which there is no clear link with the microbiota, were used as negative controls. We conducted a patient cohort study using complete population data from Swedish national registers between 2005 and 2020. The final study population comprised 26,527 colon cancer and 12,312 rectal cancer cases with a 4.5 year exposure window. In colon cancer patients, antibiotics use was associated with a higher risk of surgical site infections (adjusted odds ratio (aOR) for any versus no use = 1.20, 95% confidence interval (CI) 1.10–1.33) and anastomotic leakage in particular (aOR =1.19, 95% CI 1.03–1.36), both with dose–response relationships for increasing cumulative antibiotics use (Ptrend = <0.001 and Ptrend = 0.047, respectively). Conversely, associations in rectal cancer patients, as well as for the negative controls cardiovascular/neurological complications and methenamine hippurate, were null. In conclusion, prescription antibiotics use up to 4.5 years before colorectal cancer surgery is associated with a higher risk of surgical site infections, including anastomotic leakage, after colon cancer but not rectal cancer surgery. These findings support a role for antibiotics-induced intestinal dysbiosis in surgical site infections.

Abstract Image

结肠癌(而非直肠癌)手术后,手术部位感染(包括吻合口渗漏)的风险升高与之前接触抗生素有关:一项对 38839 名患者进行的登记研究。
肠道微生物群的组成与结直肠癌手术后手术部位并发症有关。抗生素会影响肠道微生物群,但有证据表明抗生素对手术部位并发症的影响尚无定论。我们旨在研究手术前几年处方抗生素的使用与术后 30 天内手术部位感染(包括吻合口渗漏)风险的关系。心血管/神经系统并发症和尿液杀菌剂甲氰咪胍七醋酸酯(与微生物群没有明确联系)被用作阴性对照。我们利用 2005 年至 2020 年瑞典国家登记册中的完整人口数据进行了一项患者队列研究。最终的研究人群包括26527例结肠癌和12312例直肠癌病例,暴露窗口期为4.5年。在结肠癌患者中,抗生素的使用与较高的手术部位感染风险相关(任何使用与未使用的调整赔率(aOR)=1.20,95% 置信区间(CI)1.10-1.33),特别是吻合口漏(aOR =1.19,95% CI 1.03-1.36),两者都与抗生素累积使用量的增加呈剂量反应关系(Ptrend = trend = 0.047,分别为0.047)。相反,直肠癌患者以及阴性对照组心血管/神经系统并发症和海马酸甲萘醌的相关性为零。总之,结肠癌手术前 4.5 年内使用处方抗生素与结肠癌手术后较高的手术部位感染(包括吻合口渗漏)风险有关,但与直肠癌手术无关。这些发现支持抗生素引起的肠道菌群失调在手术部位感染中的作用。
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来源期刊
CiteScore
13.40
自引率
3.10%
发文量
460
审稿时长
2 months
期刊介绍: The International Journal of Cancer (IJC) is the official journal of the Union for International Cancer Control—UICC; it appears twice a month. IJC invites submission of manuscripts under a broad scope of topics relevant to experimental and clinical cancer research and publishes original Research Articles and Short Reports under the following categories: -Cancer Epidemiology- Cancer Genetics and Epigenetics- Infectious Causes of Cancer- Innovative Tools and Methods- Molecular Cancer Biology- Tumor Immunology and Microenvironment- Tumor Markers and Signatures- Cancer Therapy and Prevention
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