Add on Ornidazole prior to surgery reduces surgical site infections: BMJ

1g dosage of ornidazole given before surgery dramatically decreased surgical site infections in persons having elective colorectal surgery when compared to a placebo, says an article published in the British Medical Journal.

One of the most frequent infections in the healthcare industry is surgical site infection, which is linked to higher mortality, morbidity, and attributable healthcare expenditures. With estimated incidence rates of up to 26%, patients undergoing colorectal surgery are particularly vulnerable to surgical site infections. The effectiveness of oral antibiotic prophylaxis in preventing surgical site infection following colorectal surgery is still unknown, and different organizations have different recommendations. Therefore, Emmanuel Futier and team conducted this study with the purpose to determine if surgical site infections following elective colorectal surgery may be decreased by oral antimicrobial prophylaxis in addition to intravenous antibiotic prophylaxis.

This experiment was double-blind, placebo-controlled, multicenter, and randomized. The study covered 11 university and non-university hospitals in France between 25 May 2016 and 8 August 2019. 926 people had elective colorectal surgery planned. In addition to intravenous antibacterial prophylaxis before surgical incision, patients were randomized to take either a single 1 g dosage of ornidazole (n = 463) or a placebo (n = 463) orally 12 hours prior to surgery. The percentage of patients who experienced surgical site infection within 30 days following surgery was the main result. Surgical site infections of various kinds and serious postoperative sequelae within 30 days after surgery were considered secondary outcomes (Clavien-Dindo classification grade 3 or above).

The key findings of this study were:

1. 926 patients (96%) out of the 960 that were enrolled were taken into account in the study. Participants' average age was 63 years, and 554 (or 60%) of them were males.

2. Infection at the surgical site occurred in 60 of 463 patients (13%) who received oral prophylaxis and 100 of 463 patients (22%) who received a placebo within 30 days following surgery.

3. Patients with deep infections made up 4.8% of the oral prophylaxis group and 8.0% of the placebo group, respectively.

4. Organ space infections affected 5.0% of participants in the oral prophylaxis group and 8.4% of patients in the placebo group.

5. Major postoperative problems affected 9.1% of individuals receiving oral prophylaxis and 13.6% of those receiving a placebo.

In conclusion, an adjunct to intravenous antibiotic prophylaxis, oral antimicrobial prophylaxis with a single oral dose of 1 g ornidazole resulted in a significantly lower rate of surgical site infection within 30 days after surgery in this large pragmatic multicenter trial in patients undergoing elective colorectal surgery.

Reference:

Futier, E., Jaber, S., Garot, M., Vignaud, M., Panis, Y., Slim, K., Lucet, J.-C., Lebuffe, G., Ouattara, A., El Amine, Y., Couderc, P., Dupré, A., De Jong, A., Pottecher, J., Pereira, B., & Paugam-Burtz, C. (2022). Effect of oral antimicrobial prophylaxis on surgical site infection after elective colorectal surgery: multicentre, randomised, double blind, placebo controlled trial. In BMJ (p. e071476). BMJ. https://doi.org/10.1136/bmj-2022-071476