A Regional Survey of the Use of Antibiotics for Mechanical Bowel Preparations Prior to Colorectal Surgery

Background: Recent studies have questioned the preventive role of mechanical bowel preparation (MBP) in colorectal surgery and the specific role of oral antibiotics.  Surgeons are reluctant to stop using MBP, in part because no professional guidelines have taken a formal stance on its role.  At Detroit Medical Center (DMC), there has been ongoing discussion regarding the use of oral antibiotics as part of MBP among surgeons and antimicrobial stewardship committee.

Objective: Survey opinions of colorectal surgeons in the region regarding their practice and opinions of MBP.  We also sought to compare results from DMC to other hospitals.

Methods: An electronic survey was distributed to colorectal surgeons via email. The survey consisted of 10 closed questions and additional space where participants could add comments.

Results: Results are shown in Table.  Of the twenty surgeons who responded, 13 (65%) practiced at DMC. Overall, only 10 (50%) of the surgeons felt that MBP was unnecessary, though 19 (95%) thought that the current data questioning the efficacy of MBP was scientifically valid.  Most respondents stated that they do not routinely use oral antibiotics.  When comparing results between the DMC and non-DMC surgeons, DMC surgeons felt that hospital guidelines should state against the routine use of MBP (p=0.03).  In addition, DMC surgeons less frequently used antibiotics as part of MBP compared to other surgeons (p=0.06).

Conclusions: Most colorectal surgeons in Southeastern Michigan recognized that good data exist supporting stopping the routine use of antibiotics for MBP. Active steps by leadership personnel at DMC facilitated a change in culture and practice related to oral antibiotics as part of MBP for colorectal surgery.

Survey question	Agree (total cohort, n=20)	Agree (DMC, n=13)	Agree (non-DMC, n=7)
MBP, including both antibacterial and non-antibacterial components, are unnecessary	10 (50%)	8 (62%)	2 (28%)
I think antibiotics are an important part of MBP	5 (25%)	2 (15%)	3 (43%)
Current data questioning the role of antibiotics in MBP is scientifically valid	19 (95%)	13 (100%)	6 (86%)
I do not routinely use antibiotics for MBP	16 (80%)	12 (92%)	4 (57%)
I am considering stopping routine use of  antibiotics for MBP in the near future	13 (65%)	11 (85%)	2 (29%)
Hospital guidelines should state that it is not advisable to routinely use antibiotics for MBP	12 (60%)	10 (77%)	2 (28%)
Antibiotics in MBP have important roles in addition to antibacterial activity (such as motility and immuno-modulating effects)	3 (15%)	1 (8%)	2 (28%)
Antibiotics in MBP increases the risk for infections caused by resistant organisms	7 (35%)	6 (46%)	1 (14%)
Use of antibiotics in MBP reduces the risk for infectious complications following colorectal surgery	5 (25%)	2 (15%)	3 (43%)
If I stopped using antibiotics for MBP I would be concerned about potential legal repercussions	5 (25%)	4 (31%)	1 (14%)