• Tsutomu Oshima, Yoshio Takesue, Hiroki Ikeuchi, Hiroki Matsuoka, Kazuhiko Nakajima, Motoi Uchino, Naohiro Tomita, and Mitsuru Sasako.
• 1 Department of Surgery, Hyogo College of Medicine, Mukogawa-cho, Nishinomiya-shi, Hyogo, Japan 2 Department of Infection Control and Prevention, Hyogo College of Medicine, Mukogawa-cho, Nishinomiya-shi, Hyogo, Japan.
• Dis. Colon Rectum. 2013 Oct 1;56(10):1149-55.

BackgroundThe usefulness of preoperative oral antibiotics for the prevention of surgical site infection in elective colorectal surgery remains controversial.ObjectiveThis study aimed to investigate the effects of oral antimicrobial prophylaxis in addition to intravenous antimicrobial prophylaxis on patients with ulcerative colitis undergoing restorative proctocolectomy.DesignThis study was a randomized, nonblinded, single-center clinical trial.SettingThis study was conducted between July 1, 2006, and April 30, 2009, at Hyogo College of Medicine.PatientsTwo hundred patients with ulcerative colitis scheduled to undergo restorative proctocolectomy with IPAA with an open approach were randomly assigned to either group A or B (n = 100). Combined use of preoperative oral antibiotics and intravenous antimicrobial prophylaxis were given to group A, and intravenous antimicrobial prophylaxis alone was given to group B.InterventionsPatients in group A received oral antibiotics the day before surgery (500 mg of kanamycin and 500 mg of metronidazole at 2:00 P.M., 3:00 P.M., and 9:00 P.M.), whereas those in group B did not. All patients underwent preoperative mechanical bowel preparation, and intravenous antimicrobial prophylaxis with second-generation cephalosporin was given for 24 hours.Main Outcome MeasuresThe primary end point of this study was the incidence of overall surgical site infection according to intention-to-treat analysis.ResultsThe incidence of overall surgical site infection was significantly lower in group A (6/97 patients, 6.1%) than in group B (22/98 patients, 22.4%) (p = 0.0024). In multivariate analysis, the administration of oral antibiotics (OR, 0.178; 95% CI, 0.057-0.552; p = 0.003) and ASA score ≥3 (OR, 5.343; 95% CI, 1.595-17.891; p = 0.007) were independent risk factors for surgical site infection.LimitationsThis study is limited because of its open-label nature.ConclusionsCombined oral and intravenous antimicrobial prophylaxis in patients with ulcerative colitis undergoing restorative proctocolectomy with IPAA contributed to the prevention of surgical site infection.

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