Anvendelse af antibiotika ved kolorektal kirurgi i Danmark

INTRODUCTION: The aim of the study was to investigate the use of antibiotics in scheduled and acute colorectal surgery in Denmark and on the basis of this and a literature research, to recommend possible antibiotic strategies. MATERIAL AND METHODS: In 2004, a written questionnaire regarding the antibiotic treatment in scheduled operations for colorectal cancer and acute colorectal surgery was submitted to all 39 surgical departments in Denmark which at the time performed colorectal surgical procedures. RESULTS: The response rate was 97%. 17 different antibiotic regimes using five different kinds of drugs were used for antibiotic prophylaxis (AP) in scheduled surgery, and if antibiotic treatment was continued, 20 regimes with six different kinds of drugs were used. In case of faecal contaminations, 76% would continue the antibiotic treatment in planned surgery and 100% in acute surgery. Of these, 17% and 14% respectively were without sufficient aerobe gram-negative coverage after the operation because the treatment with ampicillin or cefuroxime was not continued on the day of the operation. For severe obese patients, 8% of the departments used higher dosage. CONCLUSION: None of the numerous applied antibiotic strategies were inappropriate from a microbiological point of view. However, the combination of metronidazole and ampicillin must be regarded as suboptimal due to a high prevalence of ampicillin resistant Escherichia coli. If the antibiotic treatment is continued after the operation, ampicillin or cefuroxime must be administered again later on the day of the operation. Severe obese patients need higher dosage of antibiotics. The following strategies can be recommended: Cefuroxime plus metronidazol or ampicillin plus gentamicin plus metronidazole