BACKGROUND: Mechanical bowel preparation before colectomy is controversial for several reasons, including a theoretically increased risk of Clostridium difficile infection. OBJECTIVE: The primary aim of this study was to compare the incidence of C difficile infection among patients who underwent mechanical bowel preparation and those who did not. A secondary objective was to assess the association between C difficile infection and the use of oral antibiotics. DESIGN: This was an observational cohort study. SETTING: The Michigan Surgical Quality Collaborative Colectomy Project (n = 24 hospitals) participates in the American College of Surgeons-National Surgical Quality Improvement Program with additional targeted data specific to patients undergoing colectomies. PATIENTS: Included were adult patients (21 years and older) admitted to participating hospitals for elective colectomy between August 2007 and June 2009. MAIN OUTCOME MEASURE: The main outcome measure was laboratory detection of a positive C difficile toxin assay or stool culture. RESULTS: Two thousand two hundred sixty-three patients underwent colectomy and fulfilled inclusion criteria. Fifty-four patients developed a C difficile infection, for a hospital median rate of 2.8% (range, 0-14.7%). Use of mechanical bowel preparation was not associated with an increased incidence of C difficile infection (P = .95). Among 1685 patients that received mechanical bowel preparation, 684 (41%) received oral antibiotics. The proportion of patients in whom C difficile infection was diagnosed after the use of preoperative oral antibiotics was smaller than the proportion of patients with C difficile infection who did not receive oral antibiotics (1.6% vs 2.9%, P = .09). LIMITATIONS: The potential exists for underestimation of C difficile infection because of the study's strict data collection criteria and risk of undetected infection after postoperative day 30. CONCLUSIONS: In contrast to previous single-center data, this multicenter study showed that the preoperative use of mechanical bowel preparation was not associated with increased risk of C difficile infection after colectomy. Moreover, the addition of oral antibiotics with mechanical bowel preparation did not confer any additional risk of infection.
BACKGROUND:Mechanical bowel preparation before colectomy is controversial for several reasons, including a theoretically increased risk of Clostridium difficile infection. OBJECTIVE: The primary aim of this study was to compare the incidence of C difficileinfection among patients who underwent mechanical bowel preparation and those who did not. A secondary objective was to assess the association between C difficileinfection and the use of oral antibiotics. DESIGN: This was an observational cohort study. SETTING: The Michigan Surgical Quality Collaborative Colectomy Project (n = 24 hospitals) participates in the American College of Surgeons-National Surgical Quality Improvement Program with additional targeted data specific to patients undergoing colectomies. PATIENTS: Included were adult patients (21 years and older) admitted to participating hospitals for elective colectomy between August 2007 and June 2009. MAIN OUTCOME MEASURE: The main outcome measure was laboratory detection of a positive C difficile toxin assay or stool culture. RESULTS: Two thousand two hundred sixty-three patients underwent colectomy and fulfilled inclusion criteria. Fifty-four patients developed a C difficileinfection, for a hospital median rate of 2.8% (range, 0-14.7%). Use of mechanical bowel preparation was not associated with an increased incidence of C difficileinfection (P = .95). Among 1685 patients that received mechanical bowel preparation, 684 (41%) received oral antibiotics. The proportion of patients in whom C difficileinfection was diagnosed after the use of preoperative oral antibiotics was smaller than the proportion of patients with C difficileinfection who did not receive oral antibiotics (1.6% vs 2.9%, P = .09). LIMITATIONS: The potential exists for underestimation of C difficileinfection because of the study's strict data collection criteria and risk of undetected infection after postoperative day 30. CONCLUSIONS: In contrast to previous single-center data, this multicenter study showed that the preoperative use of mechanical bowel preparation was not associated with increased risk of C difficileinfection after colectomy. Moreover, the addition of oral antibiotics with mechanical bowel preparation did not confer any additional risk of infection.
Authors: Michael J Englesbe; Linda Brooks; James Kubus; Martin Luchtefeld; James Lynch; Anthony Senagore; John C Eggenberger; Vic Velanovich; Darrell A Campbell Journal: Ann Surg Date: 2010-09 Impact factor: 12.969
Authors: Eloy Espin-Basany; Jose Luis Sanchez-Garcia; Manuel Lopez-Cano; Roberto Lozoya-Trujillo; Meritxell Medarde-Ferrer; Lluis Armadans-Gil; Laia Alemany-Vilches; Manuel Armengol-Carrasco Journal: Int J Colorectal Dis Date: 2005-04-21 Impact factor: 2.571
Authors: Rodney Eddi; Mohammed N Malik; Rada Shakov; Walid J Baddoura; Chandra Chandran; Vincent A Debari Journal: Nephrology (Carlton) Date: 2010-06 Impact factor: 2.506
Authors: Caroline M E Contant; Wim C J Hop; Hans Pieter van't Sant; Henk J M Oostvogel; Harm J Smeets; Laurents P S Stassen; Peter A Neijenhuis; Floris J Idenburg; Cees M Dijkhuis; Piet Heres; Willem F van Tets; Jos J G M Gerritsen; Wibo F Weidema Journal: Lancet Date: 2007-12-22 Impact factor: 79.321
Authors: Marc Zerey; B Lauren Paton; Amy E Lincourt; Keith S Gersin; Kent W Kercher; B Todd Heniford Journal: Surg Infect (Larchmt) Date: 2007-12 Impact factor: 2.150
Authors: Scott Steele; Anton Bilchik; John Eberhardt; Philip Kalina; Aviram Nissan; Eric Johnson; Itzhak Avital; Alexander Stojadinovic Journal: Interact J Med Res Date: 2012-09-19