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Antibiotic resistance in Enterobacteriaceae: what impact on the efficacy of antibiotic prophylaxis in colorectal surgery?

Published:January 06, 2015DOI:https://doi.org/10.1016/j.jhin.2014.11.016

      Summary

      Antibiotic prophylaxis, introduced in the 1940s, brought in an era of relatively safe colorectal surgery. This was achieved in part due to the prevention of surgical site infections (SSIs) caused by Enterobacteriaceae. Since then, Enterobacteriaceae have become increasingly resistant to the antibiotics commonly used for prophylaxis. The impact of being colonized preoperatively with resistant Enterobacteriaceae on the efficacy of colorectal SSI prophylaxis, if any, is unknown. It is also difficult to predict the likely impact of resistance as the exposure‒response relationships have not been determined for antibiotic surgical prophylaxis. Neither is it known which test for resistance to use; the importance of the concentration of Enterobacteriaceae in the colon, the ability of different species of Enterobacteriaceae to cause SSIs, and the comparative ability of minimum inhibitory concentration or presence of a resistance mechanism in predicting SSI risk have yet to be established. Clinical research is urgently needed to answer these questions.

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      Linked Article

      • Microbiological prediction of surgical site infection risk after colorectal surgery: a feasibility study
        Journal of Hospital InfectionVol. 90Issue 3
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          Surgical site infections (SSIs) after colorectal surgery are an important cause of morbidity and mortality.1 Prevention of these SSIs by antibiotic prophylaxis is an effective intervention, reported to reduce superficial and deep SSI rates from 40% to 10%.2 Amoxicillin‒clavulanic acid is often administered as antibiotic prophylaxis, but resistance to amoxicillin‒clavulanic acid has been increasing.3 It is therefore possible that antibiotic prophylaxis may be becoming less effective. Currently, there is limited evidence about the impact of Enterobacteriaceae that are resistant to antibiotics on the efficacy of antibiotic prophylaxis in colorectal surgery.
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