Bowel preparation traditionally consists of cathartics, oral antibiotics, and intravenous antibiotics.
Dr Sherry Wren hypothesize that the use of oral antibiotics in bowel preparation results in a higher rate of postoperative Clostridium difficile colitis.
The investigators conducted a retrospective case-controlled study of elective colon surgery patients from 1997 to 2003.
The investigative team undertook the study in a tertiary care veterans administration hospital.
The investigators reviewed records of 304 patients who underwent elective colorectal surgery.
Patients with bowel obstruction or emergent operation were excluded.
|Rate of C difficile<\i> infection was 7% with oral antibiotics vs 3% for those without|
|Archives of Surgery|
The investigators' main outcome was detection of C difficile toxin A/B by enzyme-linked immunosorbent assay in a stool specimen within 30 days of surgery.
All patients received both cathartics and intravenous antibiotics.
Of 304 patients, 107 received oral antibiotics.
The investigators found that the rate of postoperative C difficile colitis was 4% in the entire study population.
The team noted that the rate of C difficile infection was 7% in patients who received oral antibiotics and 3% for those who did not receive oral antibiotics.
There were no C difficile-related mortalities.
Dr Wren's team commented, “Oral nonabsorbable antibiotics in bowel preparation resulted in a higher rate of C difficile infection.”
“This may be due to the additional effect of oral antibiotics on normal bowel flora.”
“We recommend that oral nonabsorbable antibiotics not be used in preoperative bowel preparation regimens since postoperative C difficile infection can lead to additional morbidity, length of stay, and hospital costs.”