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part of the flora in this anatomical region. Due to the nature of the gastrointestinal tract, it was believed that oral
antibiotic prophylaxis and mechanical bowel preparation (MBP) could achieve intestinal sterilization and thus ensure a safe
surgical intervention. However, studies have shown that MBP did not have an overall beneficial effect on postoperative
complications and caused significant patient discomfort, so it was almost abandoned. Today, it is known that about 16%
of surgical infections are caused by multiresistant bacteria, and only oral antibiotic prophylaxis is not sufficient to prevent
these infections. Namely, in the race between bacterial resistance and the development of new antibiotics, antibiotics are
increasingly lagging, and the treatment of complications remains a nightmare for surgeons. For this reason, the prevention
of SSI in colorectal surgery is a challenge for 21st-century medicine. In modern surgery, both open and laparoscopic, the
first and second generations of intravenous cephalosporins are most often used for prophylactic purposes, as antibiotics
of a sufficiently broad spectrum, with favorable pharmacokinetics and rare side effects. New research indicates that in
colorectal surgery, the combination of standard intravenous prophylaxis with the addition of an oral antimicrobial the
day before surgery is superior when it comes to SSI prevention. However, there are still no clear recommendations on the
regimen and type of antibiotics and they should be given in institutional guides and protocols, taking into account the
bacterial spectrum in the local environment, as well as resistance, and the availability of appropriate drugs. Therapeutic use
of antibiotics is reserved for acute conditions in colorectal surgery and its complications. For therapeutic purposes, more
potent antibiotics are used against the expected pathogens, usually a combination of several antibiotics, such as third or
fourth-generation cephalosporins, metronidazole, fluoroquinolones, or piperacillin/tazobactam and others. When it comes
to the therapeutic use of antibiotics in colorectal surgery, research indicates that the most important thing is to recognize
the infection in time and immediately start treatment, correct the therapy according to the causative agent, and also to
stop the administration of antibiotics in time, to avoid unwanted complications and already advanced bacterial resistance.

Keywords: colorectal surgery, antibiotics, prophylaxis, therapy, bacterial resistance

Literatura 11. Waksman SA, Bugie E, Schatz A. Isolation of antibiotic substances
from soil micro-organisms, with special reference to streptothricin and
streptomycin. Proc Staff Meet Mayo Clin. 1944;19(23):537-48.
1. Tsai DM, Caterson EJ. Current preventive measures for health-care 12. Powers JH. Antimicrobial drug development--the past, the present, and
associated surgical site infections: a review. Patient Saf Surg. 2014 Oct the future. Clin Microbiol Infect. 2004 Nov;10 Suppl 4:23-31.
11;8(1):42.
13. Nichols RL, Condon RE. Preoperative preparation of the colon. Surg
2. Kolasiński W. Surgical site infections - review of current knowledge, Gynecol Obstet. 1971 Feb;132(2):323-37.
methods of prevention. Pol Przegl Chir. 2018 Nov 6;91(4):41-7.
14. Nichols RL, Broido P, Condon RE, Gorbach SL, Nyhus LM. Effect of
3. Surveillance of surgical site infections and prevention indicators in preoperative neomycin-erythromycin intestinal preparation on the
European hospitals - HAI-Net SSI protocol, version 2.2. In: European incidence of infectious complications following colon surgery. Ann Surg.
Centre for Disease Prevention and Control. ; 2017. 1973 Oct;178(4):453-62.
4. Mukagendaneza MJ, Munyaneza E, Muhawenayo E, Nyirasebura D, 15. Cannon JA, Altom LK, Deierhoi RJ, Morris M, Richman JS, Vick CC, et al.
Abahuje E, Nyirigira J, et al. Incidence, root causes, and outcomes Preoperative oral antibiotics reduce surgical site infection following
of surgical site infections in a tertiary care hospital in Rwanda: a elective colorectal resections. Dis Colon Rectum. 2012 Nov;55(11):1160-
prospective observational cohort study. Patient Saf Surg. 2019 Feb 6.
18;13:10.
16. Mik M, Berut M, Trzcinski R, Dziki L, Buczynski J, Dziki A. Preoperative
5. Bellows CF, Mills KT, Kelly TN, Gagliardi G. Combination of oral non- oral antibiotics reduce infections after colorectal cancer surgery.
absorbable and intravenous antibiotics versus intravenous antibiotics Langenbecks Arch Surg. 2016 Dec;401(8):1153-62.
alone in the prevention of surgical site infections after colorectal
surgery: a meta-analysis of randomized controlled trials. Tech 17. Geroulanos S, Marathias K, Kriaras J, Kadas B. Cephalosporins in
Coloproctol. 2011 Dec;15(4):385-95. surgical prophylaxis. J Chemother. 2001 Nov;13 Spec No 1(1):23-6.
6. Eagye KJ, Nicolau DP. Deep and organ/space infections in patients 18. Rollins KE, Javanmard-Emamghissi H, Lobo DN. Impact of mechanical
undergoing elective colorectal surgery: incidence and impact on bowel preparation in elective colorectal surgery: A meta-analysis. World
hospital length of stay and costs. Am J Surg. 2009 Sep;198(3):359-67. J Gastroenterol. 2018 Jan 28;24(4):519-36.
7. Crader MF, Varacallo M. Preoperative Antibiotic Prophylaxis. 2023 May 19. Gravante G, Caruso R, Andreani SM, Giordano P. Mechanical bowel
29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; preparation for colorectal surgery: a meta-analysis on abdominal and
2023 Jan–. systemic complications on almost 5,000 patients. Int J Colorectal Dis.
2008 Dec;23(12):1145-50.
8. Bassetti M, Righi E, Astilean A, Corcione S, Petrolo A, Farina EC, et
al. Antimicrobial prophylaxis in minor and major surgery. Minerva 20. Bratzler DW, Hunt DR. The surgical infection prevention and surgical
Anestesiol. 2015 Jan;81(1):76-91. care improvement projects: national initiatives to improve outcomes for
patients having surgery. Clin Infect Dis. 2006 Aug 1;43(3):322-30.
9. de Jonge SW, Boldingh QJJ, Solomkin JS, Dellinger EP, Egger M, Salanti G,
et al. Effect of postoperative continuation of antibiotic prophylaxis on 21. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition
the incidence of surgical site infection: a systematic review and meta- of health care-associated infection and criteria for specific types
analysis. Lancet Infect Dis. 2020 Oct;20(10):1182-92. of infections in the acute care setting. Am J Infect Control. 2008
10. Lockwood JS, Young AD, Bouchelle M, Bryant TR, Stojowski AJ. Appraisal Jun;36(5):309-32.
of Oral Streptomycin as an Intestinal Antiseptic, with Observations on 22. Nelson RL, Gladman E, Barbateskovic M. Antimicrobial prophylaxis
Rapid Development of Resistance of E. Coli to Streptomycin. Ann Surg. for colorectal surgery. Cochrane Database Syst Rev. 2014 May
1949 Jan;129(1):14-21. 9;2014(5):CD001181.

88 DOI: 10.5937/Galmed2307086L