Summary
A prospective randomized trial was designed to establish whether parenteral antibiotic prophylaxis was as effective as oral antimicrobial bowel preparation in preventing sepsis after colorectal surgery. Patients scheduled for elective resection of colorectal cancer received metronidazole and kanamycin either orally in the preoperative phase or parenterally as a short-term perioperative prophylaxis. The former regimen resulted in reduction of the microbial concentrations in the bowel contents in the absence of therapeutic serum concentrations at the time of operation, whereas the latter achieved therapeutic intraoperative serum levels without altering the colonic microflora. 72 patients were studied. There was no significant difference in the occurrence of postoperative sepsis between the two groups (a total of 72 patients). These results differ from those obtained at the Birmingham General Hospital using the same protocol, in which postoperative sepsis was significantly more common in the group of patients having oral bowel preparation. This difference was most probably due to an overgrowth of kanamycin-resistant coliforms during the period of oral antibiotic preparation. The presence of resistant organisms did not, however, result in failure of systemic prophylaxis. The authors conclude that short-term parenteral application is the safer method of antibiotic prophylaxis in colorectal surgery and is to be preferred to oral antimicrobial bowel preparation.
Zusammenfassung
In einer prospektiven randomisierten Studie wurden zwei Methoden der Antibioticaprophylaxe in der colorectalen Chirurgie miteinander verglichen. 72 Patienten, bei denen eine elektive Operation wegen eines Colonoder Rectumcarcinoms durchgeführt wurde, erhielten Kanamycin and Metronidazol entweder oral, im Rahmen der präoperativen Darmvorbereitung, oder i. v., im Sinne einer kurzfristigen perioperativen Abschirmung. Bei der ersten Gruppe wurde eine Reduktion der aeroben und anaeroben Keimzahl im Darmlumen ohne therapeutische Serumkonzentrationen der verwendeten Medikamente erreicht, während bei der zweiten Gruppe wirksame interoperative Serumkonzentrationen ohne Veränderung der Keimzahlen im Darmlumen bestanden. Es ergab sich zwischen den beiden Gruppen keine signifikanten Unterschiede in der Häufigkeit der postoperativen Infekte. Diese Resultate stehen im Gegensatz zu denjenigen, die eine Arbeitsgruppe am Birmingham-General Hospital mit dem gleichen Studienprotokoll verzeichnete. In Birmingham waren postoperative Infektionen in der oral vorbereiteten Gruppe signifikant häufiger. Dieser Unterschied ist mit größter Wahrscheinlichkeit durch das Überwuchern Kanamycin-resistenter Bakterienstämme während der präoperativen oralen antibiotischen Vorbereitung bedingt. Das Vorhandensein resistenter Colistämme schien aber die Wirksamkeit der intravenösen Abschirmung nicht wesentlich zu beeinträchtigen. Die Autoren schließen daraus, daß die parenterale, kurzfristige Abschirmung der oralen Darmvorbereitung mit Antibiotica vorzuziehen ist.
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Aeberhard, P., Flückiger, M., Berger, J. et al. Antibiotische Darmvorbereitung oder perioperative parenterale Abschirmung bei Coloneingiffen?. Langenbecks Arch Chiv 353, 233–240 (1981). https://doi.org/10.1007/BF01266008
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DOI: https://doi.org/10.1007/BF01266008