Combined Mechanical and Oral Antibiotic Bowel Preparation Versus Oral Antibiotics Alone for the Reduction of Surgical Site Infection Following Elective Colorectal Resection
Overview
- Phase
- Early Phase 1
- Intervention
- Polyethylene Glycol
- Conditions
- Colorectal Neoplasms
- Sponsor
- Thomas Jefferson University
- Enrollment
- 224
- Locations
- 1
- Primary Endpoint
- Incidence of post-operative surgical site infection (SSI) including superficial/incisional, deep, and organ space, anastomotic dehiscence and leak
- Last Updated
- 7 years ago
Overview
Brief Summary
This randomized clinical trial studies how well neomycin and metronidazole hydrochloride with or without polyethylene glycol work in reducing infection in patients undergoing elective colorectal surgery. Polyethylene glycol, may draw water from the body into the colon, flushing out the contents of the colon. Antibiotics, like neomycin and metronidazole hydrochloride, may stop bacteria from growing. It is not yet known whether it's better to give preoperative neomycin and metronidazole hydrochloride with or without polyethylene glycol in reducing surgical site infection after colorectal surgery.
Detailed Description
PRIMARY OBJECTIVES: I. To estimate the difference in rates of surgical site infection following elective colorectal resections in patients given a preoperative mechanical bowel prep with oral antibiotics as compared to preoperative oral antibiotics alone. SECONDARY OBJECTIVES: I. To determine rates of post-operative clostridium difficile infection, adynamic ileus, cardiopulmonary complications, urinary tract infection, length of stay and mortality in patients given preoperative oral antibiotics with a mechanical bowel prep versus preoperative antibiotics alone.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Patients undergoing ileocolic resections, partial and total colectomies, and rectal resections for neoplasm, inflammatory bowel disease, or diverticulitis
- •Subjects with the mental capacity to give informed consent
Exclusion Criteria
- •Patients undergoing emergent colorectal resections
- •Patients who are decisionally-impaired and lack the mental capacity to give informed consent
Arms & Interventions
Arm I (mechanical bowel prep, oral antibiotics)
Patients receive polyethylene glycol orally (PO), neomycin PO, and metronidazole hydrochloride PO on day -1. Patients undergo colorectal resection on day 0.
Intervention: Polyethylene Glycol
Arm I (mechanical bowel prep, oral antibiotics)
Patients receive polyethylene glycol orally (PO), neomycin PO, and metronidazole hydrochloride PO on day -1. Patients undergo colorectal resection on day 0.
Intervention: Neomycin
Arm I (mechanical bowel prep, oral antibiotics)
Patients receive polyethylene glycol orally (PO), neomycin PO, and metronidazole hydrochloride PO on day -1. Patients undergo colorectal resection on day 0.
Intervention: Metronidazole Hydrochloride
Arm I (mechanical bowel prep, oral antibiotics)
Patients receive polyethylene glycol orally (PO), neomycin PO, and metronidazole hydrochloride PO on day -1. Patients undergo colorectal resection on day 0.
Intervention: Therapeutic Conventional Surgery
Arm II (oral antibiotics)
Patients receive neomycin PO and metronidazole hydrochloride PO on day -1. Patients undergo colorectal resection on day 0.
Intervention: Neomycin
Arm II (oral antibiotics)
Patients receive neomycin PO and metronidazole hydrochloride PO on day -1. Patients undergo colorectal resection on day 0.
Intervention: Metronidazole Hydrochloride
Arm II (oral antibiotics)
Patients receive neomycin PO and metronidazole hydrochloride PO on day -1. Patients undergo colorectal resection on day 0.
Intervention: Therapeutic Conventional Surgery
Outcomes
Primary Outcomes
Incidence of post-operative surgical site infection (SSI) including superficial/incisional, deep, and organ space, anastomotic dehiscence and leak
Time Frame: Up to 30 days post operation
The difference in incidence of SSI (antibiotics \[ABX\] - ABX + prep) will be calculated with an upper 95% confidence bound. Exploratory analysis will consider stratum specific estimates of differences in subgroups defined by BMI and diabetes status.
Secondary Outcomes
- Incidence of adynamic ileus(Up to 30 days post operation)
- Incidence of cardiopulmonary complications(Up to 30 days post operation)
- Incidence of urinary tract infection(Up to 30 days post operation)
- Length of hospital stay(Up to 30 days post operation)
- Incidence of post-operative clostridium difficile infection(Up to 30 days post operation)
- Incidence of mortality(Up to 30 days post operation)