Prevention and treatment of infection in colorectal surgery

The results of a personal series of clinical trials on the use of antimicrobial agents for treatment and prevention of infection in colorectal surgery are presented, together with a review of the recent literature. The studies indicate that colorectal surgery is associated with a high sepsis rate which may lead to serious complications. In elective operations, an efficient mechanical bowel preparation is extremely important if antimicrobial prophylaxis is to succeed. Short‐term systemic antimicrobial prophylaxis with an agent specifically active against anaerobic bacteria is effective for elective operations. In emergency colorectal operations in which mechanical bowel preparation is not possible and the operative field is already contaminated, more prolonged antimicrobial cover is advised using a combination of agents effective against both the principal aerobic and anaerobic pathogens. In contaminated operations, wounds should also be left open to avoid synergistic infection in the subcutaneous tissues .