The online version of this article (https://doi.org/10.1007/s10096-018-3435-z) contains supplementary material, which is available to authorized users.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Standard bolus-dosed antibiotic prophylaxis may not inhibit growth of antibiotic resistant colonic bacteria, a cause of SSIs after colorectal surgery. An alternative strategy is continuous administration of antibiotic throughout surgery, maintaining concentrations of antibiotics that inhibit growth of resistant bacteria. This study is a pilot comparing bolus-continuous infusion with bolus-dosed cefuroxime prophylaxis in colorectal surgery. This is a pilot randomised controlled trial in which participants received cefuroxime bolus-infusion (intervention arm) targeting free serum cefuroxime concentrations of 64 mg/L, or 1.5 g cefuroxime as a bolus dose four-hourly (standard arm). Patients in both arms received metronidazole (500 mg intravenously). Eligible participants were adults undergoing colorectal surgery expected to last for over 2 h. Results were analysed on an intention-to-treat basis. The study was successfully piloted, with 46% (90/196) of eligible patients recruited and 89% (80/90) of participants completing all components of the protocol. A trialled bolus-continuous dosing regimen was successful in maintaining free serum cefuroxime concentrations of 64 mg/L. No serious adverse reactions were identified. Rates of SSIs (superficial and deep SSIs) were lower in the intervention arm than the standard treatment arm (24% (10/42) vs. 30% (13/43)), as were infection within 30 days of operation (41% (17/43) vs 51% (22/43)) and urinary tract infections (2% (1/42) vs. 9% (4/43)). These infection rates can be used to power future clinical trials. This study demonstrates the feasibility of cefuroxime bolus-continuous infusion of antibiotic prophylaxis trials, and provides safety data for infusions targeting free serum cefuroxime concentrations of 64 mg/L. Trial registration: NCT02445859.
HES data: Health and Social Care Information Centre. Hospital Episode Statistics. http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937. Accessed 11June 2018
Kirby A, Burnside G, Bretsztajn L, Burke D (2015) Post-operative infections following colorectal surgery in an English teaching hospital. Infect Dis (Lond) 47:825–829 CrossRef
Petrosillo N, Drapeau CM, Nicastri E, Martini L, Ippolito G, Moro ML (2008) Surgical site infections in Italian hospitals: a prospective multicenter study. BMC Infect Dis 8:4 CrossRef
Nelson RL, Gladman E, Barbateskovic M (2014) Antimicrobial prophylaxis for colorectal surgery. Cochrane Database Syst Rev 5:CD001181
Itani KM, Jensen EH, Finn TS, Tomassini JE, Abramson MA (2008) Effect of body mass index and ertapenem versus cefotetan prophylaxis on surgical site infection in elective colorectal surgery. Surg Infect 9:131–137 CrossRef
Asín-Prieto E, Soraluce A, Trocóniz IF, Campo Cimarras E, Sáenz de Ugarte Sobrón J, Rodríguez-Gascón A, Isla A (2015) Population pharmacokinetic models for cefuroxime and metronidazole used in combination as prophylactic agents in colorectal surgery: model-based evaluation of standard dosing regimens. Int J Antimicrob Agents 45:504–511 CrossRefPubMed
Nascimento JW, Carmona MJ, Strabelli TM, Auler JO Jr, Santos SR (2007) Perioperative cefuroxime pharmacokinetics in cardiac surgery. Clinics (Sao Paulo) 62:257–260 CrossRef
Public Health England. Surveillance of surgical site infections in NHS hospitals in England, 2016 to 2017. Public health England, December 2017. Available from: www.gov.uk/phe. Accessed 11 June 2017
Health Protection Agency (2012) English national point prevalence survey on healthcare associated infections and antimicrobial use, 2011: preliminary data HPA, London
(EUCAST) ECoAST. Cefuroxime: rationale for the EUCAST clinical breakpoints (2010) http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Rationale_documents/Cefuroxime_iv_Rationale_Document_1.0_2010Nov.pdf. Accessed 11 June 2018
Shogan BD, Belogortseva N, Luong PM, Zaborin A, Lax S, Bethel C, Ward M, Muldoon JP, Singer M, An G, Umanskiy K, Konda V, Shakhsheer B, Luo J, Klabbers R, Hancock LE, Gilbert J, Zaborina O, Alverdy JC (2015) Collagen degradation and MMP9 activation by Enterococcus faecalis contribute to intestinal anastomotic leak. Sci Transl Med 7:286ra68 CrossRefPubMedPubMedCentral
- Colo-Pro: a pilot randomised controlled trial to compare standard bolus-dosed cefuroxime prophylaxis to bolus-continuous infusion–dosed cefuroxime prophylaxis for the prevention of infections after colorectal surgery
Flora Agnes Burns
Iñaki F. Trocóniz
- Springer Berlin Heidelberg
European Journal of Clinical Microbiology & Infectious Diseases
Print ISSN: 0934-9723
Elektronische ISSN: 1435-4373
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II