Systematic review of perioperative selective decontamination of the digestive tract in elective gastrointestinal surgery

BackgroundStudies on selective decontamination of the digestive tract (SDD) in elective gastrointestinal surgery have shown decreased rates of postoperative infection and anastomotic leakage. However, the prophylactic use of perioperative SDD in elective gastrointestinal surgery is not generally accepted. MethodsA systematic review of randomized clinical trials (RCTs) was conducted to compare the effect of perioperative SDD with systemic antibiotics (SDD group) with systemic antibiotic prophylaxis alone (control group), using MEDLINE, Embase and the Cochrane Central Register of Controlled Trials. Endpoints included postoperative infection, anastomotic leakage, and in-hospital or 30-day mortality. ResultsEight RCTs published between 1988 and 2011, with a total of 1668 patients (828 in the SDD group and 840 in the control group), were included in the meta-analysis. The total number of patients with infection (reported in 5 trials) was 77 (192 per cent) of 401 in the SDD group, compared with 118 (282 per cent) of 418 in the control group (odds ratio 058, 95 per cent confidence interval 042 to 082; P=0002). The incidence of anastomotic leakage was significantly lower in the SDD group: 19 (33 per cent) of 582 patients versus 44 (74 per cent) of 595 patients in the control group (odds ratio 042, 024 to 073; P=0002). ConclusionThis systematic review and meta-analysis suggests that a combination of perioperative SDD and perioperative intravenous antibiotics in elective gastrointestinal surgery reduces the rate of postoperative infection including anastomotic leakage compared with use of intravenous antibiotics alone.