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Orale Antibiotikaprophylaxe zur Darmdekontamination vor elektiver kolorektaler Chirurgie

Aktuelle Evidenzlage und Empfehlungen

Oral antibiotic prophylaxis for bowel decontamination before elective colorectal surgery

Current body of evidence and recommendations

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Zusammenfassung

Die präoperative Darmvorbereitung ist Gegenstand kontroverser Diskussionen, obwohl es eine wachsende Evidenzlage gibt, die sich auf randomisierte kontrollierte Studien, Registerdaten und Metaanalysen stützt. Zum heutigen Zeitpunkt ist eine alleinige mechanische Darmvorbereitung aufgrund des fehlenden Nachweises eines Vorteils bezüglich der Risikoreduktion für infektiöse Komplikationen, Anastomoseninsuffizienz, Morbidität und Mortalität obsolet und sollte nicht mehr durchgeführt werden. Neben der obligaten intravenösen Antibiotikaprophylaxe zeigt eine zusätzliche orale Antibiotikagabe eine additive Risikoreduktion um bis zu 50 % für das Auftreten postoperativer infektiöser Komplikationen. Der Effekt einer kombinierten oralen und intravenösen Antibiotikaprophylaxe zusammen mit einer mechanischen Darmreinigung ist bisher nicht ausreichend untersucht und bedarf weiterer Studien. Aktuell kann unabhängig von der präoperativen Darmdekontamination ein Auftreten einer Anastomoseninsuffizienz nicht verhindert werden.

Abstract

Despite a growing body of evidence from randomized controlled studies, register data and meta-analyses, there is an ongoing controversy about decontamination of the digestive tract before elective colorectal surgery. Currently, mechanical bowel preparation alone can no longer be recommended as there is a lack of evidence for an advantage in terms of risk reduction for infectious complications, anastomotic leakage, morbidity and mortality. In contrast, the administration of oral antibiotics in addition to the obligatory intravenous single shot antibiotic prophylaxis has shown an additive reduction of the risk of up to 50% for the occurrence of postoperative infectious complications; however, due to a lack of data it is unclear if mechanical bowel preparation could even improve the positive effects of combined intravenous and oral antibiotics. Therefore, further studies are necessary. At the current time the occurrence of anastomotic leakage cannot be prevented, independent of whether preoperative bowel decontamination is performed.

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Authors and Affiliations

  1. Klinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum für Operative Medizin (ZOM), Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland

    S. Flemming MD & C.-T. Germer MD

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Correspondence to S. Flemming MD.

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Interessenkonflikt

S. Flemming und C.-T. Germer geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Flemming, S., Germer, CT. Orale Antibiotikaprophylaxe zur Darmdekontamination vor elektiver kolorektaler Chirurgie. Chirurg 91, 128–133 (2020). https://doi.org/10.1007/s00104-019-01079-5

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