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SummarySerious post-operative infectious complications requiring intensive care treatment were seen régularly in patients undergoing major abdominal surgery before peri-operative antimicrobial prophylaxis was introduced. A prospective multi-centre study was carried out to study intensive care requirements in patients undergoing elective surgery of the alimentary tract in hospitals using a standardized antimicrobial prophylaxis regimen of a single intravenous dose of 400 mg doxycycline plus 1600 mg tinidazole 1-hour pre-operatively or at induction of anaesthesia. Only 56 (3.6%) out of the 1537 patients included in the study were treated in an intensive care unit for more than 1 day. Post-operative infectious complications related to peri-operative endogenous contamination were the reason for intensive care treatment in only 4 (0.26%) patients. It is concluded that such infectious complications are no longer the major reason for intensive care treatment after elective gastro-intestinal surgery and the substantial reduction in their frequency has been due to the use of ‘short-term barrier’ antimicrobial prophylaxis.

SummaryA prospective, multi-centre study was carried out in 572 patients undergoing colorectal surgery to investigate the effectiveness of a standardized antibiotic regimen as prophylaxis against post-operative infectious problems. Surgical departments used a single intravenous dose of 400 mg doxycycline plus 1600 mg tinidazole given 1-hour pre-operatively or at induction of anaesthesia. Patients were evaluated clinically 3, 7 and 15 days after surgery. Analysis of the results showed that 18 (3.1%) developed surgical infectious complications. Only 3 (0.5%) of the 21 patients who died during the hospital stay or observation period did so because of septic complications. No serious side-effects were seen. Overall compliance rate with the regimen was 96.9%. There were no signs of declining antibiotic efficacy in hospitals which had been using this regimen for up to 10 years.

SummaryThe influence of some pre-operative factors on infectious complications after elective abdominal surgery was investigated in a prospective multi-centre study of 1537 patients in surgical departments regularly using a standardized prophylactic antibiotic regimen. A total of 1101 patients received 1600 mg tinidazole plus 400 mg doxycycline intravenously 1-hour pre-operatively. Analysis of the results showed that increasing age, malignancy, risk factors noted by the surgeon before the surgical procedure, and discrepancies between assumed disease and peri-operative findings were associated with significantly more post-operative complications, but not more infectious complications related to peri-operative contamination. Pre-operative hospital stay did not influence the infection rate provided that prophylaxis was given.

SummaryThe incidence of post-operative infectious complications after high-risk biliary and gastroduodenal and all cases of small bowel surgery was investigated in 965 patients included in a prospective multi-centre study. Selected types of operation where antibiotic prophylaxis was considered beneficial were defined and patients in these categories were to receive a standardized prophylactic regimen of 400 mg doxycycline plus 1600 mg tinidazole intravenously 1-hour pre-operatively or at induction of anaesthesia. Of the 965 patients, 408 did not receive prophylaxis, 547 received the standard regimen and 10 were given a different prophylaxis. The overall compliance rate with the protocol was 89%. Analysis of the results of clinical evaluation of the patients 3, 7 and 15 days after surgery showed that only 21 (2.1%) of the 965 patients had developed surgical infectious complications. Two (0.2%) patients died of septic complications. No serious side-effects of the prophylactic regimen were recorded.

SummaryA prospective multi-centre study was carried out on 1537 patients to investigate the influence of some peri-operative factors on the infectious complications after elective abdominal surgery in surgical departments where a standardized prophylactic antibiotic regimen is used regularly. The antibiotic regimen consisted of 1600 mg tinidazole and 400 mg doxycycline given intravenously 1-hour pre-operatively. The results showed that total gastrectomy seemed to give higher infection rates than other gastroduodenal procedures. Low anterior and abdominoperineal rectal resections were followed by more infectious complications than colonic resections, but this difference was significant only due to the perineal wound infections and failures of the low anterior anastomosis. Prolonged operation time was followed by increased number of infectious complications only when prophylaxis was not given. Blood transfusions led to a highly significant increase in infectious complications. Peri-operative surgical complications, splenectomy and stoma formation did not influence post-operative infectious complications.