Detalle Publicación


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

Autores: Kirby, Andrew (Autor de correspondencia); Asín Prieto, Eduardo; Burns, Flora Agnes; Ewin, Duncan; Fatania, Kavi; Kailavasan, Mithun; Nisar, Saira; Pericleous, Agamemnon; Fernández de Trocóniz Fernández, José Ignacio; Burke, Dermot
ISSN: 1435-4373
Volumen: 38
Número: 2
Páginas: 357 - 363
Fecha de publicación: 2019
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 64mg/L, or 1.5g cefuroxime as a bolus dose four-hourly (standard arm). Patients in both arms received metronidazole (500mg intravenously). Eligible participants were adults undergoing colorectal surgery expected to last for over 2h. 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 64mg/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 30days of operation (41% (17/43) vs 51% (22/43)) and urinary tract infections (2% (1/42) vs. 9% (4/43)). Th