Perioperative infection prophylaxis and risk factor impact in colon surgery

Background: A prospective observational study was undertaken in 2,481 patie nts undergoing elective colon resection in 114 German centers to identify o ptimal drug and dosing modalities and risk factors for postoperative infect ion. Methods: Patients were pair matched using six risk factors and divided into 672 pairs (ceftriaxone vs, other cephalosporins, group A) and 400 pai rs (ceftriaxone vs. penicillins, group B). End points were local and system ic postoperative infection and cost effectiveness. Results: Local infection rates were 6.0 versus 6.5% (group A) and 4.0 versus 10.5% (group B); syste mic infection rates in groups A and B were 4.9 versus 6.3% and 3.3 versus 1 0.5%, respectively. Ceftriaxone was more effective than penicillins overall (6.8 vs. 17.8%, p < 0.001). Length of postoperative hospital stay was 16.2 versus 16.9 days (group A) and 15.8 versus 17.6 days (group B). Of the six risk factors, age and concomitant disease were significant for systemic in fection, and blood loss, rectum resection and immunosuppressive therapy wer e significant for local infection. Penicillin was a risk factor compared to ceftriaxone (p < 0.0001). Ceftriaxone saved Q160.7 versus other cephalospo rins and O416.2 versus penicillins. Conclusion: Clinical and microbiologica l efficacy are responsible for the cost effectiveness of ceftriaxone for pe rioperative prophylaxis in colorectal surgery. Copyright (C) 2000 S. Karger AG, Basel.