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At least 19 recordsLinked to original sources
PubMed1990

[Preoperative oral antimicrobial bowel preparations in elective colorectal surgery].

Colorectal surgery is associated with high incidence of postoperative wound infection due to contamination of the field of operation by organisms from the intestine. A consecutive series of 300 patients undergoing elective operations on the colon and rectum, was studied to determine the efficacy of oral antibacterial preparations on the influence of intestinal organisms at operation and the incidence of postoperative wound infection. The patients were divided into four groups as their preoperative bowel preparations as follows; 1st group: mechanical preparation alone, 2nd group: mechanical preparation and oral kanamycin, 3rd group: mechanical preparation and oral kanamycin and metronidazole, and 4th group: mechanical preparation and oral polymyxin B and metronidazole. The results of bacteriological studies on specimens taken by swab from colonic lumen and wound at operation showed effectiveness of kanamycin and polymyxin B against aerobic gram-negative rods and metronidazole against anaerobes. The rates of postoperative wound infection were 47.5% in 1st group, 27% in 2nd group, 12% 3rd group, and 2.7% in 4th group, respectively.

Administration, Oral↗
PubMedDate not supplied

Problems and complications associated with colorectal surgery.

Successful colorectal surgery requires a combination of thorough patient evaluation and surgical judgment to determine the correct surgical approach and to properly apply the general principles of colorectal surgery. These principles include gentle tissue handling, preservation of blood and nerve supply, proper suture selection and suture techniques, postoperative monitoring, and early recognition and treatment of complications.

Animals↗
PubMed1987

Systemic Timentin is superior to oral tinidazole for antibiotic prophylaxis in elective colorectal surgery. University of Melbourne Colorectal Group.

A prospective, randomized, single-blind, controlled clinical trial was undertaken to compare two different prophylactic antibiotic regimens in patients undergoing elective colorectal surgery. Systemic Timentin, a combination of ticarcillin and the beta-lactamase inhibitor clavulanic acid, was assigned to 101 patients. Oral tinidazole, an agent active only against anaerobic bacteria, was assigned to 102 patients. The wound infection rate was 2.4 percent in the patients receiving Timentin and 14 percent in those receiving tinidazole (P = 0.01). Multivariate analysis of factors affecting the wound infection rate showed that the only factor that independently reached statistical significance was the prophylactic antibiotic used. The mortality of patients receiving Timentin prophylaxis was 3.4 percent compared with 8.9 percent of those receiving tinidazole (P = 0.15). The clinical anastomotic leakage rate was 1.3 percent in patients receiving Timentin and 13 percent in those receiving tinidazole (P = 0.01). These results, together with those of two previously published clinical trials by this group, indicate that antibiotic prophylaxis in elective colorectal surgery should consist of a short course of an agent effective against both aerobic and anaerobic bowel flora.

Administration, Oral↗
PubMed1985

Should antimicrobial prophylaxis in colorectal surgery include agents effective against both anaerobic and aerobic microorganisms? A double-blind, multicenter study. The Norwegian Study Group for Colorectal Surgery.

It is now well demonstrated that a mixed flora of aerobic and anaerobic microorganisms will be found in wound abscesses and peritonitis after bowel surgery. An impressive reduction in infectious complications caused by anaerobic microorganisms can be achieved with nitroimidazole prophylaxis, but considerable uncertainty about the role of agents active against aerobic microorganisms in such prophylaxis still exists. We have earlier reported that a single dose of tinidazole and doxycycline significantly reduces postoperative infections and is superior to doxycycline alone. The effect of an agent active only against anaerobic microorganisms was tested in a double-blind study of 267 patients who underwent elective colorectal surgery. The patients received either tinidazole (1600 mg) and placebo or tinidazole (1600 mg) and doxycycline (400 mg) as a single preoperative infusion. Patients who received tinidazole and doxycycline had significantly fewer infectious complications, reoperations, additional use of antibiotics, and a shorter hospital stay. Microbiologic studies demonstrated that tinidazole alone gave effective protection against anaerobic organisms but did not protect the patients from aerobic gram-negative infectious complications. A single preoperative dose of antimicrobial agents effective against both anaerobic and aerobic bowel organisms seems to be the preferred prophylaxis for patients undergoing colorectal surgery.

Adolescent↗
PubMed1989

A comparison of single-dose systemic Timentin with mezlocillin for prophylaxis of wound infection in elective colorectal surgery. University of Melbourne Colorectal Group.

A prospective, randomized, single-blind, controlled clinical trial was undertaken to compare two different prophylactic antibiotic single-dose regimens in patients undergoing elective colorectal surgery. Timentin, a combination of ticarcillin and clavulanic acid, was administered intravenously (3.1 g) to 87 patients. Mezlocillin, a semisynthetic penicillin was given intravenously (2.0 g) to 98 patients. The wound infection rate was 10.6 percent in patients receiving Timentin and 9.7 percent in those receiving mezlocillin (P greater than .05). Multivariate analysis of factors possibly affecting the wound infection rate showed that the presence of a colostomy preoperatively, fecal contamination at surgery, and the surgical group were the only factors that independently achieved a statistically significant association with the development of a postoperative wound infection in this trial (P less than .0001).

Clavulanic Acids↗
PubMed1991

Single dose imipenem-cilastatin compared with three doses of cefuroxime and metronidazole as prophylaxis in elective colorectal surgery: a prospective randomized study.

A prospective randomized study was performed with 61 patients undergoing elective surgery for colorectal cancer, to evaluate the prophylactic effect of two different parenteral antibiotic regimens. All patients were randomly allocated into two groups, comparable in age, sex, nutritional status and operative procedures. The patients in Group A (n. 31) received 1 g i.v. of imipenem-cilastatin at induction of anesthesia. Patients in Group B (n. 30) were given cefuroxime (1.5 g i.v.) plus metronidazole (0.5 g i.v.) at the time of anesthesia and two other administrations of the combined antibiotics (cefuroxime 0.75 g plus metronidazole 0.5 g i.v.) every 8 hours. The severity of sepsis was evaluated according to the scoring system proposed by Elebute and Stoner. No significant differences were found in terms of the rate of surgical infections: 9% in Group A and 16% in Group B. Infections not of surgical origin were found only in Group B (10.4%). These data suggest that a single dose of intravenous imipenem-cilastatin appears to be as effective as three doses of cefuroxime and metronidazole as prophylaxis against infection in elective colorectal surgery.

Adult↗
PubMed1988

Systemic perioperative prophylaxis in elective oncological colorectal surgery: cefotetan versus clindamicin plus aztreonam.

A prospective randomized study was performed with 65 patients undergoing elective surgery for colorectal cancer, to evaluate the prophylactic effect of two different parenteral antibiotic regimens. All patients underwent rigorous mechanical cleansing of the bowel (enemas, laxatives), received low-residue diet 3 days pre-operatively, and were given oral metronidazole (250 mg) five times a day for 3 days preoperatively. They were divided into two groups comparable in age, nutritional status and operative procedure. The patients in group A (36) received 2 g i.v. of cefotetan at induction of anaesthesia and two other administrations every 12 h. Patients in group B (29) were given clindamicin (600 mg, i.v.) at induction of anaesthesia plus aztreonam (1 g, i.v.); two other doses of the same combined antibiotics were administered every 8 h. Five patients were excluded from the study because they underwent Miles procedure; two others because they underwent explorative laparotomy only. The overall incidence of post-operative septic complications was 6.9% (4/58). No significant differences were found in terms of the rate of surgical infections: 3.1 in group A (1/32) and 0% in group B. Urinary tract infections (1 case) and respiratory tract infections (2 cases) were observed only in group B: the rate was found to be 11.5% (3/26); two anastomotic leakages were observed in group A (6.25%) and one in group B (3.8%). These data suggest that cefotetan appears to be as effective as clindamicin plus aztreonam in prophylaxis against infection in elective colorectal surgery.

Adult↗
PubMed1989

[Evaluation of rapid colon preparation by oral intake of dulcolax for colorectal surgery].

The optimal result of colorectal surgery is best achieved by adequate preoperative colon preparation, which should be simple, safe, rapid, and thoroughly clean with little or no discomfort at all for patients. Conventional mechanical preparation, though effective, is time-consuming and unpleasant for patients, therefore new methods have been frequently presented in recent literature to meet the above ideal. A prospective and randomized study was conducted to evaluate preoperative colon preparation in elective, nonobstructive colorectal surgery. Group I included 32 patients who received three-day diet control and enema, while group II included 42 patients who received one-day diet control and oral dulcolax. Both groups were given systemic antibiotics. The result favored group II because of its significantly less abdominal fullness, but the electrolyte change and bacteriologic study revealed no significant difference between two groups. Neither did they exhibit variance in the adequacy of bowel cleansing (81.3% in group I vs 81% in group II). It is therefore suggested that, without enema and with less abdominal fullness, oral dulcolax should be encouraged for colon preparation in colorectal surgery.

Administration, Oral↗
PubMedDate not supplied

Prophylaxis of infection following colorectal surgery.

Due to the high incidence of infective complications following colorectal surgery, prophylactic application of systemic antibiotics is required. In a prospective, randomised study of 34 patients who underwent elective colorectal surgery, it was found that a single 1 g dose of cefotaxime was as effective as three doses in controlling post-operative infections. Both groups received 500 mg metronidazole i.v. every 12 h for 72 h, with the first dose administered immediately prior to surgery. The results indicate that prophylactic cefotaxime and metronidazole are effective in reducing the incidence of septic complications following colorectal surgery; nevertheless, a study with a larger number of patients is needed to reach a definitive conclusion.

Adolescent↗
PubMed1986

Clinical trial of prophylaxis of wound sepsis in elective colorectal surgery comparing ticarcillin with tinidazole. University of Melbourne Colorectal Group.

A prospective randomized single blind controlled clinical trial was undertaken to compare prophylactic therapy using a systemic antibiotic active against both aerobic and anaerobic bacteria with an oral antibiotic agent active only against anaerobic bacteria in elective colorectal surgery. One hundred and thirty-one patients received ticarcillin and 130 received tinidazole. The wound infection rate was 8% in those patients receiving ticarcillin prophylaxis and 20% in those receiving tinidazole (P less than 0.05). Multivariate analysis of the factors affecting wound infection rate showed that there were three independent factors that reached statistical significance: the prophylactic antibiotic used; the type of hospital (public or private) in which the operation was performed, and the presence of a stoma at operation. The wound infection rate in those patients receiving tinidazole prophylaxis was more than twice that reported previously by the authors. The mortality in patients receiving ticarcillin prophylaxis was 1.5% compared to 9.2% in those receiving tinidazole prophylaxis (P less than 0.05). The clinical anastomotic leakage rate was similar in each antibiotic prophylactic group, 8.6% in those receiving ticarcillin and 7.3% in those receiving tinidazole.

Administration, Oral↗
PubMed1987

[Current status of perioperative preventive use of antibiotics in colorectal surgery].

The rate of postoperative wound infections following colorectal surgery can be considerably reduced by rational perioperative short-time antibiotic prophylaxis. The anaerobic and aerobic microflora of the colon as well as the half-life of the medicaments used have to be taken into due consideration for good choice of antibiotics. Persistent orthograde intestinal flushing, using physiological electrolyte solution without any addition of antibiotics, on the eve of surgery as well as perioperative antibiotic prophylaxis "en flash", using slow-drop intravenous infusion of 1 g Ornidazole and 2 g Mezlocilline along with introduction of anaesthesia, made for a good approach to reducing wound infections following colorectal surgery to two per cent. Twice as much antibiotics were administered for 24 to 28 hours in emergency cases in which preoperative intestinal flushing was not possible. This helped to reduce the rate of postoperative infections from 32 to six per cent.

Anti-Bacterial Agents↗
PubMed1989

[Enoxacin concentrations in serum and in the wall of the colon during colorectal surgery].

For successful prophylaxis of postoperative infections in colorectal surgery the administered antibiotic must reach sufficiently high concentrations in plasma and gut wall. Therefore, in ten patients receiving 400 mg enoxacin orally about 2 h prior to operation (in addition to their routine perioperative intravenous prophylaxis with amoxicillin and clavulanic acid) concentrations of enoxacin were determined by HPLC in plasma (samples were taken at the beginning of operation, time of tissue sampling and each hour during the operation) and in gut wall. We found the following plasma concentrations (mean +/- S.D.): beginning of operation 2.53 ( +/- 1.07) mg/l, 1 h later 2.08 ( +/- 0.82) mg/l, 2 h later 1.60 ( +/- 0.65) mg/l. At the time of tissue sampling (on an average 185 min after the enoxacin dose) the plasma concentration was 2.27 ( +/- 1.02) mg/l, the gut wall concentration was 3.74 ( +/- 1.58) mg/kg, the ratio between the two concentrations was 1.70 ( +/- 0.27). It seems warranted to study orally administered enoxacin (in combination with an antibiotic against anaerobes) in prophylaxis of infections after colorectal surgery.

Aged↗
PubMed1991

New advances in antibiotic prophylaxis for colorectal surgery.

The major advances in antibiotic prophylaxis in colorectal surgery have come from an awareness of the need for appropriate agents against the known likely pathogens and from knowledge of the pharmacokinetics of these drugs. Intensive study has been undertaken to identify optimal regimens, but as there is great variability in the settings under which these operations take place, it is not always possible to compare the results of these various investigations. There is little doubt that in many cases there is gross contamination with faecal organisms and the term prophylaxis is inappropriate so that prolonged courses of antibiotics would appear to be safer. However, work towards identifying patients at increased susceptibility of developing septic complications may well further improve the outcome of colorectal surgery.

Anti-Bacterial Agents↗
PubMed1988

Prophylactic antibiotics in elective colorectal surgery.

A randomized prospective study was conducted on 194 patients who underwent elective colorectal surgery for carcinoma. All patients received the same mechanical bowel preparation. In addition, patients in group A received oral neomycin and erythromycin base; patients in group B received systemic metronidazole and gentamicin, while patients in group C received both oral and systemic antibiotics. Postoperative septic complications related to colorectal surgery occurred in 27.4 per cent, 11.9 per cent and 12.3 per cent respectively in groups A, B and C (chi 2 = 7; P less than 0.05). The incidence of sepsis in groups B and C was almost identical. Patients who received oral antibiotics alone (group A) had significantly higher risks of postoperative sepsis when compared with patients in either group B or group C (P less than 0.05). As there is no additional advantage of combining oral and systemic antibiotics, we recommend systemic metronidazole and gentamicin to be used with mechanical bowel preparation in elective colorectal surgery.

Administration, Oral↗
PubMed1992

Evaluation of tissue oximetry in perioperative monitoring of colorectal surgery.

Twenty patients undergoing elective colorectal surgery were studied during and after operation by means of tissue oximetry measuring the subcutaneous partial pressure of oxygen (PscO2) and by gastric intramural pH measurement. Mean(s.d.) PscO2 recorded 24 h after surgery was significantly lower than the peroperative value: 14(10) versus 24(14) mmHg, P less than 0.02. The postoperative PscO2 was also significantly lower than that measured in a control group of ten healthy volunteers: 14(10) versus 34(18) mmHg, P less than 0.001. The peroperative PscO2 of the patients who developed a postoperative complication was significantly lower than that of those who had an uneventful postoperative clinical outcome: 16(9) versus 32(14) mmHg, P less than 0.02. The peroperative PscO2 of the patient group with complications was also significantly lower than that of the control group: 16(9) versus 34(18) mmHg, P less than 0.02. The peroperative PscO2 of the group of patients without complications was almost identical to that of the control group. During operation only one patient developed gastric intramural acidosis. Perioperative oxygen debt and the response of subcutaneous tissue oxygen tension to oxygen breathing seemed to correlate better with clinical outcome than gastric wall pH values and the conventional parameters of tissue perfusion.

Adult↗
PubMed1988

Are we using the correct dose of metronidazole in colorectal surgery?

In a series of 20 patients undergoing elective colorectal surgery, 10 received an infusion of metronidazole 500 mg and 10 an infusion of 1500 mg commencing at the induction of anaesthesia. The concentrations of metronidazole in the plasma, rectus muscle and colon of the two groups during the course of the operation were compared. In those patients who received 1500 mg, the plasma and tissue concentrations were all well above the minimum inhibitory concentration (MIC) of metronidazole against Bacteroides fragilis. In those patients who received 500 mg, serum and tissue concentrations were at or only just above the MIC. It may be that 1500 mg would be a more effective dose of metronidazole for prophylactic use in colorectal surgery.

Colon↗
PubMed1990

Single dose prophylaxis in colorectal surgery.

Moxalactam disodium (Latamoxef), was evaluated as a single dose prophylactic antibiotic against wound infection in open colorectal surgery. One hundred and five consecutive patients admitted to the university department of surgery, Wellington Hospital, were studied. Twelve patients were excluded because either the antibiotic was not given or antibiotics were given for other reasons. Eleven patients developed early wound infections and one further patient developed a late infection, an overall wound infection rate of 13% (95% CI 7-19). Whilst this infection rate is higher than that previously reported from this unit using more prolonged (3 dose) antibiotic prophylaxis (9.8%, 95% CI 9.6-10) the difference is not likely to be significant because the patient groups were not matched, and the comparisons were sequential. On the basis of the present study it is concluded that 1 g of moxalactam disodium administered at the induction of anaesthesia in open colorectal surgery is inexpensive, is associated with a low incidence of side effects and its further use in colorectal surgery would seem to be justified.

Aged↗
PubMed1992

Postoperative infection and natural killer cell function following blood transfusion in patients undergoing elective colorectal surgery.

The frequency of infection in 197 patients undergoing elective colorectal surgery and having either no blood transfusion, transfusion with whole blood, or filtered blood free from leucocytes and platelets was investigated in a prospective randomized trial. Natural killer cell function was measured before operation and 3, 7 and 30 days after surgery in 60 consecutive patients. Of the patients 104 required blood transfusion; 48 received filtered blood and 56 underwent whole blood transfusion. Postoperative infections developed in 13 patients transfused with whole blood (23 per cent, 95 per cent confidence interval 13-32 per cent), in one patient transfused with blood free from leucocytes and platelets (2 per cent, 95 per cent confidence interval 0.05-11 per cent) and in two non-transfused patients (2 per cent, 95 per cent confidence interval 0.3-8 per cent) (P less than 0.01). Natural killer cell function was significantly (P less than 0.001) impaired up to 30 days after surgery in patients transfused with whole blood. These data provide a strong case against the use of whole blood transfusion in patients undergoing elective colorectal surgery.

Adult↗