Is There Still a Need to Discuss the Use of Antibiotic Decontamination? Results of a Prospective Cohort Study Involving 999 Left-Sided Colorectal Resections.

Abstract

Background: The benefit of antibiotic decontamination and bowel preparation (ADBP) in colorectal resections remains controversial. The objective was to evaluate the effect of ADBP in left-sided colorectal resections in an entire health-care region.

Study design: This prospective, multicenter observational trial was conducted from October 2020 to October 2022. The primary endpoint was the Comprehensive Complication Index (CCI).

Results: A total of 999 patients were included (371 in no ADBP group and 624 in ADBP group). The median age was 66 years, and 52.1% of patients were female. The median CCI in no ADBP group was 0.0 [IQR 0.0-20.9] and 0.0 in the ADBP group [IQR 0.0-8.7] (p = 0.85). The surgical site infection (SSI) rate was 10.2% in the no ADBP group and 4.8% in the ADBP group (p = 0.002). Anastomotic leakage (AL) occurred in 5.9% of patients in the no ADBP group and 4.3% in the ADBP group (p = 0.23). In a multivariate logistic regression analysis, ADBP had no impact on the occurrence of complications (OR 0.86, 95%-CI: 0.56-1.31). However, the estimated CCI was 5.79 points lower after the application of ADBP among those with complications (95%-CI: -11.50--0.08). In multivariate logistic regression the application of ADBP had no effect on the probability of SSI (OR 0.64, 95%-CI: 0.35-1.21) or AL (OR 0.72, 95%-CI: 0.39-1.36).

Conclusions: The use of ADBP in left-sided colorectal resections was associated with a reduction of the severity of overall complications. Nevertheless, there was no impact of ADBP on SSI and AL rates.