Surgical Site Infection in Colorectal Surgery: A Study in Antibiotic Duration

BACKGROUND: Despite distant historical studies that demonstrated the adequacy of preoperative antibiotic prophylaxis, current surgical practice continues to use antibiotics for postoperative coverage up to 24 hours. OBJECTIVE: The aim of this study was to evaluate a change in antibiotic prophylaxis duration and its effect on surgical site infection in a high-volume modern colorectal practice. DESIGN: A case-controlled series retrospectively reviewed outcomes through a prospective validated data base. SETTING: The study was conducted at Mayo Clinic, Rochester, Minnesota. PATIENTS: A total of 965 patients were evaluated. Our study analyzed patient outcomes related to surgical site infection comparing cohort 1 (2012–2013), which had the same antibiotic coverage preoperatively up to 24 hours postoperatively, and cohort 2 (2014–2015), which eliminated postoperative doses and relied solely on pre- and intraoperative dosing duration. MAIN OUTCOME MEASURES: The primary outcomes of this study are superficial and deep surgical site infection. RESULTS: There were no differences identified for superficial or deep surgical site infection rates between cohorts. Before the change in antibiotic dosing duration (2012–2013), 28 of 493 patients (5.7%) vs after the practice change (2014–2015), 25 of 472 patients (5.3%) were reported to have superficial or deep surgical site infection (p = 0.794). LIMITATIONS: This study is limited by its retrospective design within a single institution. CONCLUSION: These equivalent results present an opportunity for surgeons to reconsider optimal antibiotic duration and minimize unnecessary antibiotic dosing. See Video Abstract at http://ift.tt/2x27TtF .

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