A Systematic Review and Meta-Analysis Comparing the Efficacy of Enteral Antibiotics Combined With Mechanical Bowel Preparation Versus Mechanical Bowel Preparation Alone in Elective Colorectal Resections

TL;DR

This study finds that adding enteral antibiotics to standard care in colorectal surgery reduces anastomotic leaks and surgical site infections.

Contribution

The novelty lies in a systematic review and meta-analysis comparing enteral antibiotics with standard care in elective colorectal surgery.

Findings

Anastomotic leak rates were higher in the control group without enteral antibiotics.

Surgical site infections were reduced with the addition of enteral antibiotics.

Mortality and readmission rates showed no significant difference between groups.

Abstract

This study compares the outcomes of elective colorectal surgery in patients who received enteral antibiotics (EAb) in addition to standard care (SC) (mechanical bowel preparation and intravenous antibiotics) to those who received SC alone. This study will review existing research on the impact of prophylactic EAb on colorectal surgery outcomes. Relevant studies were identified from electronic medical databases and analysed using the statistical software RevMan (Review Manager 5.4, The Nordic Cochrane Centre, Copenhagen, Denmark) based on the principles of meta-analysis. A total of 13 studies (nine RCTs and four comparative trials) on 9,466 patients for postoperative outcomes were included. A random-effects model analysis was conducted, revealing that anastomotic leak rates were higher in the control group, with no heterogeneity observed. Surgical site infections were higher in the control group with moderate heterogeneity. Postoperative mortality and readmission rates were similar in both groups. The use of EAb is associated with a reduced incidence of anastomotic leaks and surgical site infections; however, readmission rates and mortality require further assessment in a major, multicenter, randomised study.

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