M. Stewart et al., INFECTION AFTER COLORECTAL SURGERY - A RANDOMIZED TRIAL OF PROPHYLAXIS WITH PIPERACILLIN VERSUS SULBACTAM PIPERACILLIN, The Journal of hospital infection, 29(2), 1995, pp. 135-142
Antibiotics used for prophylaxis in elective colorectal surgery should
be effective against the organisms contaminating the soft tissues and
isolated from postoperative infections. These are usually the enterob
acteriaceae commensal to the colon. However, staphylococcal and anaero
bic infections are not uncommon. Piperacillin has been used as antibio
tic prophylaxis and been shown to be as efficacious as an aminoglycosi
de with metronidazole. Piperacillin is susceptible to many beta-lactam
ases and we have therefore conducted a study to assess the efficacy of
adding sulbactam, a beta-lactamase inhibitor, to piperacillin for pro
phylaxis in elective colorectal surgery. Three hundred and seventy-nin
e patients were randomized to receive a single dose of piperacillin 4
g intravenously (iv) (group P, n = 192) or piperacillin 4 g with sulba
ctam 2 g iv (group SP n = 187). Fifty-three patients were withdrawn fr
om analysis leaving 168 evaluable patients in group P and 158 patients
in group SP. Postoperative infective complications occurred in 91 (28
%) patients, 55 (33%) in group P and 36 (23%) in group SP (chi(2) = 4.
0 P<0.05). Surprisingly Staphylococcus aureus was isolated from wound
infections in 22 patients (12 in group P and 10 in group SP) which rep
resents 24% of those patients who developed infective morbidity. We co
nclude that sulbactam improves the efficacy of piperacillin as prophyl
axis in elective colorectal surgery but does little to protect against
staphylococcal wound infection.