Comparative Effectiveness Of Antibiotic Prophylaxis Strategies In Preventing Surgical Site Infections In Colorectal Surgery

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Background: Surgical site infections (SSIs) remain among the most common postoperative complications following colorectal surgery and are associated with prolonged hospitalization, increased healthcare costs, higher rates of reoperation, and increased morbidity.Objective: To compare the effectiveness of different antibiotic prophylaxis strategies in preventing surgical site infections among patients undergoing colorectal surgery.Methodology: This comparative observational study was conducted at Lahore General Hospital from April 2024 to April 2025 included 145 patients who underwent elective or emergency colorectal surgery.Patients were categorized according to the prophylactic antibiotic regimen received into three groups: intravenous antibiotic prophylaxis only (n = 58), oral bowel preparation combined with intravenous antibiotic prophylaxis (n = 49), and extended postoperative antibiotic prophylaxis (n = 38).Results: Overall, surgical site infection developed in 23 (15.9%) patients.The incidence of SSI was significantly lower in the oral bowel preparation plus intravenous antibiotic group (4/49, 8.2%) than in the intravenous antibiotic only group (12/58, 20.7%) and the extended postoperative antibiotic group (7/38, 18.4%) (p = 0.046).Patients receiving oral bowel preparation combined with intravenous antibiotics also had a significantly shorter postoperative hospital stay (7.8 ± 3.1 days; p = 0.021).Multivariable logistic regression demonstrated that diabetes mellitus (adjusted OR 2.31, 95% CI 1.08-4.95;p = 0.031), BMI ≥30 kg/m² (adjusted OR 2.54, 95% CI 1.16-5.56;p = 0.020), emergency surgery (adjusted OR 2.86, 95% CI 1.29-6.37;p = 0.010), and operative duration ≥180 minutes (adjusted OR 2.63, 95% CI 1.18-5.84;p = 0.018) were independent predictors of SSI.Conclusion: Oral bowel preparation combined with intravenous antibiotic prophylaxis was more effective than intravenous antibiotic prophylaxis alone or extended postoperative antibiotic therapy in preventing surgical site infections following colorectal surgery...