An analysis of more than 100 randomized clinical trials (RCTs) provides new insight into which antibiotic regimens are most effective at preventing surgical-site infection (SSI) following colorectal surgery, researchers reported today in JAMA Network Open.
The estimated incidence of SSI after elective colorectal surgery ranges from 10% to 25%, contributing to longer hospital stays for patients and increased use of antibiotics. While most international guidelines recommend dual-agent antibiotic prophylaxis prior to incision to reduce SSI risk, a variety of antibiotic combinations are used in clinical practice, and previous studies haven’t distinguished between antibiotic classes, a team led by researchers with McMaster University in Ontario noted.
“The optimal choice of antibiotic prophylaxis in elective colorectal surgery remains uncertain, with most reviews emphasizing timing and route of administration rather than direct comparisons of antibiotic classes,” they wrote.
The systematic review and meta-analysis examined 105 RCTs involving 18,273 patients undergoing elective colorectal surgery to determine which antibiotic prophylactic regimens are associated with the lowest risk of SSI. Thirty-day mortality, adverse events, and length of hospital stay were secondary outcomes. A total of 32 distinct antibiotic regimens were evaluated across the RCTs.
Evidence base for future guidance
High-to-moderate certainty evidence indicated that, compared with compared placebo or no antibiotics, several regimens were associated with reduced risk of SSI, but broad-spectrum penicillins and third-generation cephalosporins were associated with the most substantial reduction (74% and 73%, respectively). Broad-spectrum penicillins were also associated with a 79% decrease in 30-day mortality. No significant differences were observed between antibiotic classes regarding length of hospital stay or adverse events.
The authors say the analysis “provides a more clinically meaningful perspective than prior reviews that focused primarily on route of administration.”
“These findings highlight the importance of antibiotic class selection in prophylactic strategies and provide an evidence base to guide future guideline updates and clinical practice,” they wrote.