Is There Still a Need to Discuss the Use of Antibiotic Decontamination? Results of a Prospective Cohort Study Involving 999 Left-Sided Colorectal Resections

BACKGROUND: The benefit of antibiotic decontamination and bowel preparation (ADBP) in colorectal resections remains controversial. The objective was to evaluate the effect of ADBP in left-sided colorectal resections in an entire healthcare region. STUDY DESIGN: This prospective, multicenter observational trial was conducted from October 2020 to October 2022. The primary endpoint was the Comprehensive Complication Index (CCI). RESULTS: A total of 999 patients were included (371 in no ADBP group and 624 in ADBP group). The median age was 66 years, and 52.1% of patients were women. The median CCI in no ADBP group was 0.0 (interquartile range 0.0 to 20.9) and 0.0 in the ADBP group (interquartile range 0.0 to 8.7; p = 0.85). The surgical site infection (SSI) rate was 10.2% in the no ADBP group and 4.8% in the ADBP group (p = 0.002). Anastomotic leakage (AL) occurred in 5.9% of patients in the no ADBP group and 4.3% in the ADBP group (p = 0.23). In a multivariate logistic regression analysis, ADBP had no impact on the occurrence of complications (odds ratio [OR] 0.86, 95% CI 0.56 to 1.31). However, the estimated CCI was 5.79 points lower after the application of ADBP among those with complications (95% CI -11.50 to -0.08). In multivariate logistic regression, the application of ADBP had no effect on the probability of SSI (OR 0.64, 95% CI 0.35 to 1.21) or AL (OR 0.72, 95% CI 0.39 to 1.36). CONCLUSIONS: The use of ADBP in left-sided colorectal resections was associated with a reduction of the severity of overall complications. Nevertheless, there was no impact of ADBP on SSI and AL rates.