Sadahiro, S., Suzuki, T., Tanaka, A., Okada, K., Kamata, H., Ozaki, T., & Koga, Y. (2014). Comparison between oral antibiotics and probiotics as bowel preparation for elective colon cancer surgery to prevent infection: Prospective randomized trial. Surgery, 155, 493–503.
To determine comparative effectiveness of oral antibiotics and probiotics as bowel preparation in the prevention of surgical site infection (SSI)
Patients were randomized to one of three groups. The probiotic group took bifidobacteria tablets orally after each meal three times daily for seven days preoperatively, and postoperatively for 10 days. The oral antibiotic group took 0.5 g kanamycin sulfate and 0.5 g metronidazole orally three times on the day before surgery. The control group did not receive any bowel preparation beyond standard care. All patients underwent mechanical bowel prep with sodium picosulfate two days before surgery and polyethylene glycol in the morning of the day of surgery. All patients received a single preoperative 1 g dose of flomoxef IV one hour prior to incision. The same procedures for surgical site disinfection, intraperitoneal irrigation, and suture closures were done. Operative wounds were assessed daily during the hospital stay and in an outpatient clinic four weeks after surgery.
Rates of postoperative infections, including incisional infections, organ/space SSIs, and remote infections, were 24% in the probiotic group, 11.1% in the oral antibiotic group, and 25% in the control group. Group comparisons showed that the difference in infection rate was significantly lower in the oral antibiotic group than in either other group (p < .03). Incidence of incisional SSI was lower in the oral antibiotic group (p = .014). The oral antibiotic group also had a significantly lower rate of leakage (p = .004). SSI-causing pathogens were analyzed in all patients, and most of the bacteria detected were not covered by the spectrum of flomoxef. No significant differences were observed in CD toxin detection between groups.
Findings suggest that bowel preparation with oral antibiotics is helpful in preventing postoperative infections in patients with colon cancer undergoing elective colon surgery. No benefit was shown with the use of preoperative probiotics.
Findings show that rates of postoperative infections among patients undergoing surgery for colon cancer can be reduced by the addition of oral antibiotics as part of bowel preparation. Probiotic use was not effective. Nurses can advocate for consideration of use of preoperative oral antibiotics as examined in this study and advocate for further research to confirm these findings. CD risk was not shown to be different across groups in this study, but this risk remains a consideration, particularly if oral antibiotic use is prolonged.