Identification and antibiotic prophylaxis of high‐risk patients in elective colorectal surgery

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Abstract
High‐risk patients undergoing elective colorectal surgery were identified by culturing irrigation fluid samples taken peroperatively, and the effect of supplementary antibiotics in this group was evaluated. All patients (n =267) got 600 mg doxycycline intravenously as a preoperative prophylaxis. The day after operation the high‐risk patients could be identified by a count of bacteria cultured from the irrigation fluid. They were randomly allocated either to group A (n=40), no further antibiotics, or to group B (n=45), combination of cefuroxime and metronidazole. The rate of postoperative septic complications was 20% in group A and 4.4% in group B (p<0.05). It is concluded that high‐risk patients undergoing elective colorectal surgery can be identified by culturing the irrigation fluid taken peroperatively. With supplementary antibiotic prophylaxis, the postoperative complication rate can be lowered significantly.