Colon preparation and surgical site infection

BACKGROUND: Colon preparation for elective colon resection to reduce surgical site infection (SSI) remains controversial. METHODS: A review of the published literature was undertaken to define evidence-based practices for colon preparation for elective colon resection. RESULTS: Seventy years of surgical literature has documented that mechanical bowel preparation alone does not reduce SSI. A body of clinical trials has documented the benefits of oral antibiotic bowel preparation compared with a placebo in the reduction of SSI. Clinical trials show the addition of the oral antibiotic bowel preparation to appropriate systemic preoperative preventive antibiotics provide the lowest rates of SSI. CONCLUSIONS: Mechanical bowel preparation alone does not reduce rates of SSI, but oral antibiotic preparation and systemic preoperative antibiotics are superior when compared with systemic antibiotics alone. Additional clinical trials are necessary to define the best combined overall mechanical and oral antibiotic regimen for elective colon surgery. (C) 2011 Elsevier Inc. All rights reserved.