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The role of single-shot metronidazole in the prevention of Clostridium difficile infection following ileostomy reversal surgery

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Symptomatic infection with Clostridium difficile is strongly linked to antibiotic use and rates are higher for colorectal surgery. In February 2015, trust policy for antibiotic prophylaxis of ileostomy reversal surgery was changed from three doses of metronidazole plus cefuroxime to single-dose metronidazole, in a bid to reduce rates of Clostridium difficile infection.

Methods

A retrospective cohort study was conducted at a single, large hospital trust between February 2014 and February 2016, before and after change in antimicrobial policy. Theatre data, clinical notes and pathology results were all reviewed. Outcome data, patient age, gender, length of operation and hospital stay were extracted.

Results

One hundred three patients underwent ileostomy reversal surgery between February 2014 and February 2015. All received cefuroxime together with metronidazole at induction of anaesthesia followed by two further post-operative doses as operative prophylaxis. Ninety-six patients underwent ileostomy reversal surgery between February 2015 and February 2016. All received single-dose metronidazole at induction as prophylaxis. Post-operative diarrhoea was significantly reduced in patients given single-dose metronidazole compared with patients managed with multiple dose, dual antibiotic therapy (32 vs 12.5%, P 0.001). Rates of CDI were also significantly reduced in patients given single-dose metronidazole (6.8 vs 1%, P 0.038).

Conclusions

Single-dose, pre-operative metronidazole is effective at reducing post-operative diarrhoea and CDI in ileostomy reversal surgery compared with multiple-dose cefuroxime plus metronidazole. Metronidazole may be effective as a prophylactic antibiotic against CDI in colonic surgery.

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Authors and Affiliations

  1. Department of Surgery & Cancer, Queen Alexandra Hospital, Southwick Hill Rd, Portsmouth, PO6 3LY, UK

    Roland Fernandes, Paul Robinson, Karan Rangarajan, Sophie Scott & Laura Angco

Authors
  1. Roland Fernandes
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  2. Paul Robinson
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  3. Karan Rangarajan
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  4. Sophie Scott
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  5. Laura Angco
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Corresponding author

Correspondence to Paul Robinson.

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The authors have no conflicts of interest or sources of funding to declare.

This work has not been published/presented elsewhere.

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Fernandes, R., Robinson, P., Rangarajan, K. et al. The role of single-shot metronidazole in the prevention of Clostridium difficile infection following ileostomy reversal surgery. Int J Colorectal Dis 32, 733–736 (2017). https://doi.org/10.1007/s00384-016-2725-0

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  • DOI: https://doi.org/10.1007/s00384-016-2725-0

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