Skip to main content

Advertisement

SpringerLink
Log in

Effect of preoperative oral antibiotics and mechanical bowel preparation on the prevention of surgical site infection in elective colorectal surgery, and does oral antibiotic regime matter? a bayesian network meta-analysis

  • REVIEW
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Surgical site infection (SSI) impacts 5-20% of patients after elective colorectal surgery. There are varying reports on the effectiveness of oral antibiotics (OAB) with preoperative mechanical bowel preparation (MBP) in preventing SSI. We aim to determine the role of OAB and MBP in preventing SSI after elective colorectal surgery. We also determine if a specific OAB regimen will be more effective than others.

Methods

This study investigated the impact of OAB and MBP in patients undergoing elective colorectal surgery. PubMed, MEDLINE, Ovid, Cochrane Central Register of Controlled Trials, ACP Journal Club, and Embase databases were searched for randomized clinical trials (RCTs) published by June 2022. All RCTs comparing various preoperative bowel preparation regimens, including pairwise or multi-intervention comparisons, were included. To establish the role of OAB and MBP in preventing SSI, we conducted a Bayesian network meta-analysis on all RCTs. We further performed subgroup analysis to determine the most effective OAB regimen.

Results

Among included 46 studies with a total of 12690 patients, patients in the MBP + OAB group were less likely to have SSI than those having MBP-only (OR 0.55, 95% CrI 0.39-0.76), and without MBP and OAB (OR 0.52, 95% CrI 0.32-0.84). OAB regimen C (kanamycin + metronidazole) and A (neomycin + metronidazole) demonstrated a significantly reduced incidence of SSI, compared to regimen B (neomycin + erythromycin) with OR 0.24 (95% CrI 0.07-0.79) and 0.26 (95% CrI 0.07-0.99) respectively.

Conclusions

OAB with MBP reduces the risk of SSI after elective colorectal surgery. Providing adequate aerobic and anaerobic coverage with OAB may confer better protection against SSI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Data availability

The data supporting this study's findings are available on request from the corresponding author.

References

  1. Leaper D, Burman-Roy S, Palanca A et al (2008) Prevention and treatment of surgical site infection: summary of NICE guidance. BMJ 337

  2. Smyth E, McIlvenny G, Enstone J et al (2008) Hospital infection society prevalence survey steering group: four country healthcare associated infection prevalence survey 2006: overview of the results. J Hosp Infect 69:230–248

    CAS  PubMed  Google Scholar 

  3. Smith RL, Bohl JK, McElearney ST et al (2004) Wound infection after elective colorectal resection. Ann Surg 239:599

    PubMed  PubMed Central  Google Scholar 

  4. Konishi T, Watanabe T, Kishimoto J et al (2006) Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance. Ann Surg 244:758

    PubMed  PubMed Central  Google Scholar 

  5. Pastor C, Baek J-H, Varma MG et al (2010) Validation of the risk index category as a predictor of surgical site infection in elective colorectal surgery. Dis Colon Rectum 53:721–727

    PubMed  Google Scholar 

  6. Nichols RL, Condon RE (1971) Preoperative preparation of the colon. Surg Gynecol Obstet 132:323–337

    CAS  PubMed  Google Scholar 

  7. Fry DE (2011) Colon preparation and surgical site infection. Am J Surg 202:225–232

    PubMed  Google Scholar 

  8. Nichols RL, Broido P, Condon RE et al (1973) Effect of preoperative neomycin-erythromycin intestinal preparation on the incidence of infectious complications following colon surgery. Ann Surg 178:453–462

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Clarke JS, Condon RE, Bartlett JG et al (1977) Preoperative Oral Antibiotics Reduce Septic Complications of Colon Operations: Results of Prospective, Randomized, Double-blind Clinical Study. Ann Surg 186

  10. Matheson DM, Arabi Y, Baxter-Smith D et al (1978) Randomized multicentre trial of oral bowel preparation and antimicrobials for elective colorectal operations. Br J Surg 65:597–600

    CAS  PubMed  Google Scholar 

  11. Morris MS, Graham LA, Chu DI et al (2015) Oral Antibiotic Bowel Preparation Significantly Reduces Surgical Site Infection Rates and Readmission Rates in Elective Colorectal Surgery. Ann Surg 261:1034–1040

    PubMed  Google Scholar 

  12. Toneva GD, Deierhoi RJ, Morris M et al (2013) Oral antibiotic bowel preparation reduces length of stay and readmissions after colorectal surgery. J Am Coll Surg 216:756–762; discussion 762–753

  13. Toh JWT, Phan K, Hitos K et al (2018) Association of Mechanical Bowel Preparation and Oral Antibiotics Before Elective Colorectal Surgery With Surgical Site Infection: A Network Meta-analysis. JAMA Netw Open 1:e183226

    PubMed  PubMed Central  Google Scholar 

  14. Rollins KE, Javanmard-Emamghissi H, Acheson AG et al (2019) The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery: A Meta-analysis. Ann Surg 270:43–58

    PubMed  Google Scholar 

  15. Nelson RL, Gladman E, Barbateskovic M (2014) Antimicrobial prophylaxis for colorectal surgery. Cochrane Database Syst Rev 2014:Cd001181

  16. Woodfield JC, Clifford K, Schmidt B et al (2022) Strategies for Antibiotic Administration for Bowel Preparation Among Patients Undergoing Elective Colorectal Surgery: A Network Meta-analysis. JAMA Surg 157:34–41

    PubMed  Google Scholar 

  17. Scarborough JE, Mantyh CR, Sun Z et al (2015) Combined Mechanical and Oral Antibiotic Bowel Preparation Reduces Incisional Surgical Site Infection and Anastomotic Leak Rates After Elective Colorectal Resection: An Analysis of Colectomy-Targeted ACS NSQIP. Ann Surg 262:331–337

    PubMed  Google Scholar 

  18. Guenaga K, Matos D, Wille‐Jørgensen P (2009) Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev

  19. McChesney SL, Zelhart MD, Green RL et al (2020) Current U.S. Pre-Operative Bowel Preparation Trends: A 2018 Survey of the American Society of Colon and Rectal Surgeons Members. Surg Infect 21:1–8

    Google Scholar 

  20. Migaly J, Bafford AC, Francone TD et al (2019) The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Use of Bowel Preparation in Elective Colon and Rectal Surgery. Dis Colon Rectum 62:3–8

    PubMed  Google Scholar 

  21. 2017 European Society of Coloproctology (ESCP) Collaborating Group, Glasbey JC, Blanco‐Colino R, Kelly M, Singh B, Bhangu A, Pinkney T, Poskus T, El‐Hussuna A, Battersby NJ, Buchs NC (2018) Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection: an international, multi-centre, prospective audit. Colorectal Dis 20:15–32

  22. Battersby CLF, Battersby NJ, Slade DAJ et al (2019) Preoperative mechanical and oral antibiotic bowel preparation to reduce infectious complications of colorectal surgery - the need for updated guidelines. J Hosp Infect 101:295–299

    CAS  PubMed  Google Scholar 

  23. Arezzo A, Mistrangelo M, Bonino MA, Salusso P, Forcignanò E, Vettoretto N, Botteri E, Cillara N, Ottonello R, Testa V, De Rosa FG (2021) Oral neomycin and bacitracin are effective in preventing surgical site infections in elective colorectal surgery: a multicentre, randomized, parallel, single-blinded trial (COLORAL-1). Updates Surg 73:1775–1786

  24. Espin Basany E, Solis-Pena A, Pellino G et al (2020) Preoperative oral antibiotics and surgical-site infections in colon surgery (ORALEV): a multicentre, single-blind, pragmatic, randomised controlled trial. Lancet Gastroenterol Hepatol 5:729–738

    Google Scholar 

  25. Pellino G, Solis-Pena A, Kraft M et al (2021) Preoperative oral antibiotics with versus without mechanical bowel preparation to reduce surgical site infections following colonic resection: Protocol for an international randomized controlled trial (ORALEV2). Colorectal disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland 23:2173–2181

    PubMed  Google Scholar 

  26. Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev 10:1–11

    Google Scholar 

  27. Sterne JA, Savović J, Page MJ et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366

  28. Horan TC, Gaynes RP, Martone WJ et al (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 13:606–608

    CAS  PubMed  Google Scholar 

  29. Gelman A, Rubin DB (1992) Inference from iterative simulation using multiple sequences. Stat Sci 7:457–472

    Google Scholar 

  30. Salanti G (2012) Indirect and mixed-treatment comparison, network, or multiple-treatments meta-analysis: many names, many benefits, many concerns for the next generation evidence synthesis tool. Research synthesis methods 3:80–97

    PubMed  Google Scholar 

  31. Dion Y, Richards G, Prentis J et al (1980) The influence of oral versus parenteral preoperative metronidazole on sepsis following colon surgery. Ann Surg 192:221

    CAS  PubMed  PubMed Central  Google Scholar 

  32. Beggs F, Jobanputra R, Holmes J (1982) A comparison of intravenous and oral metronidazole as prophylactic in colorectal surgery. Br J Surg 69:226–227

    CAS  PubMed  Google Scholar 

  33. Lazorthes F, Legrand G, Monrozies X et al (1982) Comparison between oral and systemic antibiotics and their combined use for the prevention of complications in colorectal surgery. Dis Colon Rectum 25:309–311

    CAS  PubMed  Google Scholar 

  34. Weaver M, Burdon DW, Youngs DJ et al (1986) Oral neomycin and erythromycin compared with single-dose systemic metronidazole and ceftriaxone prophylaxis in elective colorectal surgery. Am J Surg 151:437–442

    CAS  PubMed  Google Scholar 

  35. Lau W, Chu K, Poon G et al (1988) Prophylactic antibiotics in elective colorectal surgery. Br J Surg 75:782–785

    CAS  PubMed  Google Scholar 

  36. Playforth M, Smith G, Evans M et al (1988) Antimicrobial bowel preparation. Dis Colon Rectum 31:90–93

    CAS  PubMed  Google Scholar 

  37. Raahave D, Hesselfeldt P, Pedersen TB (1988) Cefotaxime iv versus oral neomycin-erythromycin for prophylaxis of infections after colorectal operations. World J Surg 12:369–372

    CAS  PubMed  Google Scholar 

  38. Kling P-A, Dahlgren S (1989) Oral prophylaxis with neomycin and erythromycin in colorectal surgery: more proof for efficacy than failure. Arch Surg 124:705–707

    CAS  PubMed  Google Scholar 

  39. Yabata E, Okabe S, Endo M (1997) A prospective, randomized clinical trial of preoperative bowel preparation for elective colorectal surgery-comparison among oral, systemic, and intraoperative luminal antibacterial preparations. J Med Dent Sci 44:75–80

    CAS  PubMed  Google Scholar 

  40. Ishida H, Yokoyama M, Nakada H et al (2001) Impact of oral antimicrobial prophylaxis on surgical site infection and methicillin-resistant Staphylococcus aureus infection after elective colorectal surgery. Results of a prospective randomized trial. Surg Today 31:979–983

    CAS  PubMed  Google Scholar 

  41. Espin-Basany E, Sanchez-Garcia JL, Lopez-Cano M et al (2005) Prospective, randomised study on antibiotic prophylaxis in colorectal surgery. Is it really necessary to use oral antibiotics? Int J Colorectal Dis 20:542–546

    PubMed  Google Scholar 

  42. Kobayashi M, Mohri Y, Tonouchi H et al (2007) Randomized clinical trial comparing intravenous antimicrobial prophylaxis alone with oral and intravenous antimicrobial prophylaxis for the prevention of a surgical site infection in colorectal cancer surgery. Surg Today 37:383–388

    CAS  PubMed  Google Scholar 

  43. Reddy B, Macfie J, Gatt M et al (2007) Randomized clinical trial of effect of synbiotics, neomycin and mechanical bowel preparation on intestinal barrier function in patients undergoing colectomy. Br J Surg 94:546–554

    CAS  Google Scholar 

  44. Oshima T, Takesue Y, Ikeuchi H et al (2013) Preoperative oral antibiotics and intravenous antimicrobial prophylaxis reduce the incidence of surgical site infections in patients with ulcerative colitis undergoing IPAA. Dis Colon Rectum 56:1149–1155

    PubMed  Google Scholar 

  45. Sadahiro S, Suzuki T, Tanaka A et al (2014) Comparison between oral antibiotics and probiotics as bowel preparation for elective colon cancer surgery to prevent infection: prospective randomized trial. Surgery 155:493–503

    PubMed  Google Scholar 

  46. Hata H, Yamaguchi T, Hasegawa S et al (2016) Oral and parenteral versus parenteral antibiotic prophylaxis in elective laparoscopic colorectal surgery (JMTO PREV 07–01): a phase 3, multicenter, open-label, randomized trial. Ann Surg 263:1085–1091

    PubMed  Google Scholar 

  47. Ikeda A, Konishi T, Ueno M et al (2016) Randomized clinical trial of oral and intravenous versus intravenous antibiotic prophylaxis for laparoscopic colorectal resection. Br J Surg 103:1608–1615

    CAS  Google Scholar 

  48. Anjum N, Ren J, Wang G et al (2017) A randomized control trial of preoperative oral antibiotics as adjunct therapy to systemic antibiotics for preventing surgical site infection in clean contaminated, contaminated, and dirty type of colorectal surgeries. Dis Colon Rectum 60:1291–1298

    PubMed  Google Scholar 

  49. Uchino M, Ikeuchi H, Bando T et al (2019) Efficacy of preoperative oral antibiotic prophylaxis for the prevention of surgical site infections in patients with Crohn disease: a randomized controlled trial. Ann Surg 269:420–426

    PubMed  Google Scholar 

  50. Abis G, Stockmann H, Bonjer H et al (2019) Randomized clinical trial of selective decontamination of the digestive tract in elective colorectal cancer surgery (SELECT trial). Br J Surg 106:355–363

    CAS  Google Scholar 

  51. Papp G, Saftics G, Szabó B et al (2021) Systemic versus Oral and Systemic Antibiotic Prophylaxis (SOAP) study in colorectal surgery: prospective randomized multicentre trial. Br J Surg 108:271–276

    CAS  PubMed  Google Scholar 

  52. Rybakov E, Nagudov M, Sukhina M et al (2021) Impact of oral antibiotic prophylaxis on surgical site infection after rectal surgery: results of randomized trial. Int J Colorectal Dis 36:323–330

    PubMed  Google Scholar 

  53. Arezzo A, Mistrangelo M, Bonino MA et al (2021) Oral neomycin and bacitracin are effective in preventing surgical site infections in elective colorectal surgery: a multicentre, randomized, parallel, single-blinded trial (COLORAL-1). Updat Surg 73:1775–1786

    Google Scholar 

  54. Burke P, Mealy K, Gillen P et al (1994) Requirement for bowel preparation in colorectal surgery. Br J Surg 81:907–910

    CAS  PubMed  Google Scholar 

  55. Santos J Jr, Batista J, Sirimarco M et al (1994) Prospective randomized trial of mechanical bowel preparation in patients undergoing elective colorectal surgery. Br J Surg 81:1673–1676

    PubMed  Google Scholar 

  56. Miettinen RPJ, Laitinen ST, Mäkelä JT et al (2000) Bowel preparation with oral polyethylene glycol electrolyte solutionvs. no preparation in elective open colorectal surgery. Dis Colon Rectum 43:669–675

    CAS  PubMed  Google Scholar 

  57. Bucher P, Gervaz P, Soravia C et al (2005) Randomized clinical trial of mechanical bowel preparation versus no preparation before elective left-sided colorectal surgery. Br J Surg92:409–414

    CAS  Google Scholar 

  58. Fa-Si-Oen P, Roumen R, Buitenweg J et al (2005) Mechanical bowel preparation or not? Outcome of a multicenter, randomized trial in elective open colon surgery. Dis Colon Rectum 48:1509–1516

    PubMed  Google Scholar 

  59. Ram E, Sherman Y, Weil R et al (2005) Is mechanical bowel preparation mandatory for elective colon surgery?: A prospective randomized study. Arch Surg 140:285–288

    PubMed  Google Scholar 

  60. Platell C, Barwood N, Makin G (2006) Randomized clinical trial of bowel preparation with a single phosphate enema or polyethylene glycol before elective colorectal surgery. Br J Surg 93:427–433

    CAS  Google Scholar 

  61. Contant CM, Hop WC, van’t Sant HP et al (2007) Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial. Lancet 370:2112–2117

    Google Scholar 

  62. Jung B, Påhlman L, Nyström P et al (2007) Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection. Br J Surg 94:689–695

    CAS  Google Scholar 

  63. Pena-Soria MJ, Mayol JM, Anula R et al (2008) Single-blinded randomized trial of mechanical bowel preparation for colon surgery with primary intraperitoneal anastomosis. J Gastrointest Surg 12:2103–2109

    PubMed  Google Scholar 

  64. Bretagnol F, Panis Y, Rullier E et al (2010) Rectal cancer surgery with or without bowel preparation: the French GRECCAR III multicenter single-blinded randomized trial. Ann Surg 252:863–868

    PubMed  Google Scholar 

  65. Bertani E, Chiappa A, Biffi R et al (2011) Comparison of oral polyethylene glycol plus a large volume glycerine enema with a large volume glycerine enema alone in patients undergoing colorectal surgery for malignancy: a randomized clinical trial. Colorectal Dis 13:e327–e334

    CAS  PubMed  Google Scholar 

  66. Sasaki J, Matsumoto S, Kan H et al (2012) Objective assessment of postoperative gastrointestinal motility in elective colonic resection using a radiopaque marker provides an evidence for the abandonment of preoperative mechanical bowel preparation. J Nippon Med Sch 79:259–266

    PubMed  Google Scholar 

  67. Saha AK, Chowdhury F, Jha AK et al (2014) Mechanical bowel preparation versus no preparation before colorectal surgery: A randomized prospective trial in a tertiary care institute. J Nat Sci Biol Med 5:421

    PubMed  PubMed Central  Google Scholar 

  68. Bhattacharjee PK, Chakraborty S (2015) An open-label prospective randomized controlled trial of mechanical bowel preparation vs nonmechanical bowel preparation in elective colorectal surgery: personal experience. Indian J Surg 77:1233–1236

    PubMed  PubMed Central  Google Scholar 

  69. Bhat AH, Parray FQ, Chowdri NA et al (2016) Mechanical bowel preparation versus no preparation in elective colorectal surgery: a prospective randomized study. Int J Surg Open 2:26–30

    Google Scholar 

  70. Mai-Phan AT, Nguyen H, Nguyen TT et al (2019) Randomized controlled trial of mechanical bowel preparation for laparoscopy-assisted colectomy. Asian J Endoscopic Surg 12:408–411

    PubMed  Google Scholar 

  71. Zmora O, Mahajna A, Bar-Zakai B et al (2003) Colon and rectal surgery without mechanical bowel preparation: a randomized prospective trial. Ann Surg 237:363

    PubMed  PubMed Central  Google Scholar 

  72. Zmora O, Mahajna A, Bar-Zakai B et al (2006) Is mechanical bowel preparation mandatory for left-sided colonic anastomosis? Results of a prospective randomized trial. Tech Coloproctol 10:131–135

    CAS  PubMed  Google Scholar 

  73. Suzuki T, Sadahiro S, Tanaka A et al (2020) Usefulness of preoperative mechanical bowel preparation in patients with colon cancer who undergo elective surgery: a prospective randomized trial using oral antibiotics. Dig Surg 37:192–198

    CAS  PubMed  Google Scholar 

  74. Koskenvuo L, Lehtonen T, Koskensalo S et al (2019) Mechanical and oral antibiotic bowel preparation versus no bowel preparation for elective colectomy (MOBILE): a multicentre, randomised, parallel, single-blinded trial. The Lancet 394:840–848

    CAS  Google Scholar 

  75. Basany EE, Solís-Peña A, Pellino G et al (2020) Preoperative oral antibiotics and surgical-site infections in colon surgery (ORALEV): a multicentre, single-blind, pragmatic, randomised controlled trial. Lancet Gastroenterol Hepatol 5:729–738

    Google Scholar 

  76. Mulder T, Kluytmans-van den Bergh M, Vlaminckx B et al (2020) Prevention of severe infectious complications after colorectal surgery using oral non-absorbable antimicrobial prophylaxis: results of a multicenter randomized placebo-controlled clinical trial. Antimicrob Resist Infect Control 9:1–11

    Google Scholar 

  77. Abis GSA, Stockmann HBAC, Bonjer HJ et al (2019) Randomized clinical trial of selective decontamination of the digestive tract in elective colorectal cancer surgery (SELECT trial). Br J Surg 106:355–363

    CAS  PubMed  Google Scholar 

  78. Kiran RP, Murray AC, Chiuzan C et al (2015) Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery. Ann Surg 262:416–425; discussion 423–415

  79. Garfinkle R, Abou-Khalil J, Morin N et al (2017) Is There a Role for Oral Antibiotic Preparation Alone Before Colorectal Surgery? ACS-NSQIP Analysis by Coarsened Exact Matching. Dis Colon Rectum 60:729–737

    PubMed  Google Scholar 

  80. Cannon JA, Altom LK, Deierhoi RJ et al (2012) Preoperative oral antibiotics reduce surgical site infection following elective colorectal resections. Dis Colon Rectum 55:1160–1166

    PubMed  Google Scholar 

  81. Pellino G, Solís-Peña A, Kraft M et al (2021) Preoperative oral antibiotics with versus without mechanical bowel preparation to reduce surgical site infections following colonic resection: Protocol for an international randomized controlled trial (ORALEV2). Colorectal Dis 23:2173–2181

    PubMed  Google Scholar 

  82. Chok AY, Zhao Y, Tan IE-H et al (2023) Cost-effectiveness comparison of minimally invasive, robotic and open approaches in colorectal surgery: a systematic review and bayesian network meta-analysis of randomized clinical trials. Int J Colorectal Dis 38:86

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore, 169608, Singapore

    Chee Hoe Koo, Aik Yong Chok, Ian Jun Yan Wee, Isaac Seow-En, Yun Zhao & Emile John Kwong Wei Tan

  2. Group Finance Analytics, Singapore Health Services, Singapore, 168582, Singapore

    Yun Zhao

Authors
  1. Chee Hoe Koo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aik Yong Chok
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ian Jun Yan Wee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Isaac Seow-En
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yun Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emile John Kwong Wei Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: Chee Hoe Koo; Emile John Kwong Wei Tan. Methodology: Chee Hoe Koo; Aik Yong Chok; Ian Wee Jun Yan; Yun Zhao. Software: Aik Yong Chok; Yun Zhao. Validation: Aik Yong Chok; Isaac Seow-En. Formal analysis: Aik Yong Chok; Yun Zhao. Investigation: Chee Hoe Koo; Emile John Kwong Wei Tan. Resources: Emile John Kwong Wei Tan. Data curation: Ian Wee Jun Yan; Yun Zhao. Writing – Original Draft: Chee Hoe Koo; Ian Wee Jun Yan; Yun Zhao. Writing – Review & Editing: all authors. Visualization: Yun Zhao. Supervision: Aik Yong Chok; Isaac Seow-En; Emile John Kwong Wei Tan. Project administration: Aik Yong Chok; Isaac Seow-En; Emile John Kwong Wei Tan. All authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Chee Hoe Koo.

Ethics declarations

Informed consent

This article contains no human studies conducted by any of the authors.

Human and animal rights

This article does not contain any human or animal experiments conducted by the authors.

Competing interests

The authors state they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 495 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Koo, C.H., Chok, A.Y., Wee, I.J.Y. et al. Effect of preoperative oral antibiotics and mechanical bowel preparation on the prevention of surgical site infection in elective colorectal surgery, and does oral antibiotic regime matter? a bayesian network meta-analysis. Int J Colorectal Dis 38, 151 (2023). https://doi.org/10.1007/s00384-023-04444-3

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00384-023-04444-3

Keywords

Search

Navigation