PERSONAL-EXPERIENCE WITH ANTIBIOTIC-PROPH YLAXIS IN ELECTIVE COLON SURGERY - RETROSPECTIVE STUDY

We reviewed in a retrospective study all our 616 electively operated c olons over 15 years from 1976 to 1990 for morbidity and mortality depe nding the antibiotic prophylaxis. Interventions were performed on 578 patients with a mean age of 65.5 + 13.7 years; in 38 cases there was a n earlier elective colic operation. The sex ratio was 1.26 men to 1 wo man. 71.8% of the indications were adenocarcinomas of the colon. All o ther diagnostics, as well as different types of interventions were inc luded in the study. All interventions was preceded by large bowel prep aration. The colic anastomosis were almost always handswen in two laye rs. Until 1982 systematically, we gave prophylaxis by combination of a minoglycoside with metronidazole or clindamycine, n = 329 (53.4% of 61 6). We then changed to ceftriaxone, n = 287 (46.6% of 616). Ceftriaxon e was applicated in single dose (n = 142), in multi doses (n = 71) and combined in almost all cases with metronidazole (n = 74). We found si gnificantly better morbidity and mortality results with ceftriaxone th an in the aminoglycoside combined group: The ceftriaxone group had a s epticemia or colocutaneous fistulas requiring reoperation incidence of 1.4% (4/287) versus 4.6% (15/329) (p = 0.023). Mortality decreased fr om 4.9% (16/329) under aminoglycoside combined prophylaxis to 1.74% (5 /287) in the ceftriaxone group (p = 0.033). The infection rate of the surgical accesses diminished from 13.1% (43/329) to 8% (23/287) under ceftriaxone (p = 0.043). The frequency of intraabdominal abscesses dec reased from 7.6% (25/329) to 3.8% (11/287) (p = 0.047). The conservati vely treated colocutaneous fistulas decreased from 6.7% (22/329) to 3. 1% (9/287) (p = 0.044). The differences of the morbidity and mortality in the subgroups of the ceftriaxone prophylaxis was not significant. -We concluded that the antibiotic prophylaxis in the elective surgery of the colon is sufficient with a 2 g ceftriaxone single dose. For pat ients at higher risk, occasional combination with metronidazole was us eful.