目的:在择期结直肠手术中,感染性并发症高达30%。近年来,一些研究讨论了结直肠手术前肠道净化的主题,以减少术后感染并发症,并发现口服抗生素和使用多种药物的显著效果。在这种情况下,没有研究评估口服巴龙霉素和甲硝唑的组合。
方法:我们进行了一项前瞻性单中心研究,并进行了配对回顾性队列研究,以评估术后感染并发症(浅表部位感染,器官空间脓肿,吻合口漏)在择期结直肠手术中。
方法:共有120例患者可纳入研究;101例患者知情同意并纳入研究。共有92名患者进行了匹配,随后进行了分析。我们可以显示干预组的整体感染并发症减少(15.2%vs30.8%,p=0.018;比值比0.333,95%CI0.142-0.784)以及浅表手术部位感染的减少(8.7vs19.6%,p=0.041,OR0.333,95%CI0.121-0.917)。其他感染性并发症如腹腔脓肿和吻合口漏的频率在干预组中显示出频率降低的趋势(OR分别为0.714,95%CI0.235-2.169和OR0.571;95%CI0.167-1.952)。最后,口服抗生素导致住院时间几乎显著缩短(12.24天vs15.25天;p=0.057).
结论:口服巴龙霉素和甲硝唑联合厄他培南可有效减少择期结直肠手术的感染并发症。
背景:该研究于2018年12月17日在Clinicaltrials.gov(NCT03759886)注册。
OBJECTIVE: Infectious complications are as high as 30% in elective colorectal surgery. In recent years, several studies have discussed the topic of preoperative bowel decontamination prior to colorectal surgery in order to reduce postoperative infectious complications and have found significant effects of oral antibiotic administration with a large variety of drugs used. No study has evaluated the combination of oral
paromomycin and metronidazole in this context.
METHODS: We performed a prospective single-center study with a matched-pair retrospective cohort to evaluate postoperative infectious complications (superficial site infections, organ space abscess, anastomotic leakage) in elective colorectal surgery.
METHODS: A total of 120 patients were available for study inclusion; 101 gave informed consent and were included. A total of 92 patients were matched and subsequently analyzed. We could show a reduction in overall infectious complications in the intervention group (15.2% vs 30.8%, p = 0.018; odds ratio 0.333, 95% CI 0.142-0.784) as well as a reduction in superficial surgical site infections (8.7 vs 19.6%, p = 0.041, OR 0.333, 95% CI 0.121-0.917). The frequency of the other infectious complications such as intraabdominal abscesses and anastomotic leakage showed a tendency towards decreased frequencies in the intervention group (OR 0.714, 95% CI 0.235-2.169 and OR 0.571; 95% CI 0.167-1.952, respectively). Finally, the oral antibiotic administration led to an almost significantly reduced length of stay (12.24 days vs 15.25 days; p = 0.057).
CONCLUSIONS: Oral
paromomycin and metronidazole with intravenous ertapenem effectively reduce infectious complications in elective colorectal surgery.
BACKGROUND: The study was registered at Clinicaltrials.gov (NCT03759886) December 17, 2018.