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Sherry M. Wren, MD, FACS; Natasha Ahmed, MD; Ayesha Jamal, MD; Bassem Y. Safadi, MD, FACS

Arch Surg. 2005;140:752-756.

Hypothesis  Bowel preparation traditionally consists of cathartics, oral antibiotics, and intravenous antibiotics. We hypothesize that the use of oral antibiotics in bowel preparation results in a higher rate of postoperative Clostridium difficile colitis.

Design  Retrospective case-controlled study of elective colon surgery patients; January 1997 to June 2003.

Setting  Tertiary care veterans administration hospital.

Patients  Records of patients who underwent elective colorectal surgery (n = 304) were reviewed. Patients with bowel obstruction or emergent operation were excluded.

Main Outcome Measure  Detection of C difficile toxin A/B by enzyme-linked immunosorbent assay in a stool specimen within 30 days of surgery.

Results  All 304 patients received both cathartics and intravenous antibiotics. Of 304 patients, 107 (35.1%) received oral antibiotics. The rate of postoperative C difficile colitis was 4.2% in the entire study population. The rate of C difficile infection was higher in patients who received oral antibiotics (7.4%) compared with patients who did not receive oral antibiotics (2.6%; P = .03). There were no C difficile–related mortalities.

Conclusion  Oral nonabsorbable antibiotics in bowel preparation resulted in a higher rate of C difficile infection. This may be due to the additional effect of oral antibiotics on normal bowel flora. We recommend that oral nonabsorbable antibiotics not be used in preoperative bowel preparation regimens since postoperative C difficile infection can lead to additional morbidity, length of stay, and hospital costs.

Author Affiliations: Palo Alto Veterans Health Care System (Drs Wren, Ahmed, Jamal and Safadi) and Department of Surgery, Stanford University School of Medicine (Drs Wren and Safadi), Palo Alto, Calif.

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