Skip to main content
PMC home page
The Journal of Hygiene logoLink to The Journal of Hygiene
. 1986 Aug;97(1):49–59. doi: 10.1017/s0022172400064342

Recolonization and colonization resistance of the large bowel after three methods of preoperative preparation of the gastrointestinal tract for elective colorectal surgery.

A E van den Bogaard, W F Weidema, C P van Boven, D van der Waay
PMCID: PMC2082873  PMID: 3734441

Abstract

The impact of three current types of preoperative large bowel preparation on the microbial flora and the colonization resistance (CR) was investigated in 15 volunteers. In the first group a whole gut irrigation was performed without administration of antibiotics (group WGI). In the second group 0.5 g/l metronidazole and 1 g/l neomycin was added to the irrigation fluid (group WGI + AB). A whole gut irrigation with prior oral administration of 1 l mannitol 10% was performed in the third group. The antibiotic prophylaxis in this group consisted of two doses of 80 mg gentamicin i.v. and 500 mg metronidazole orally 24 h after lavage (group Mann + AB). One hour after the mechanical cleansing procedure was finished all volunteers were orally contaminated with one dose of an Escherichia coli test strain. The aerobic faecal reduction due to the cleansing procedure was 2-3 logs, while for the anaerobes it was 4-5 logs. The anaerobic flora in group WGI recovered within 24 h, while the aerobes showed a transient 'overgrowth' for the period of 2 days. The overgrowth of aerobes in group WGI + AB was observed for more than a week and the total numbers of aerobes started gradually to decline after the anaerobic flora had reached pretreatment levels at day three or four. Despite the normal numbers of anaerobes present 24 h after treatment, overgrowth of E. coli was seen in the group Mann + AB, probably due to residual mannitol left in the intestinal tract. The test strain of E. coli was excreted for a period of 1 week by the volunteers in the groups WGI and Mann + AB, but it was isolated for more than 10 weeks in the group WGI + AB. It is thought that all three methods of preoperative large bowel preparation decreased the CR of the gastrointestinal tract because of a disturbance of the interaction between aerobic and anaerobic microorganisms and alterations of the colonic wall. The anaerobic microflora, however, appeared to be primarily responsible for the maintenance of the CR. Antimicrobial prophylaxis should consist of a high dose, short term, systemic antibiotic regimen, not only because an adequate serum level of an appropriate drug at the time of operation substantially decreases the incidence of postoperative septic complications but also because a systemic regimen scarcely influences the CR of the gastrointestinal tract. beta-Aspartylglycine appeared to be a specific but not very sensitive marker for decreased CR.

Full text

PDF
58

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arabi Y., Dimock F., Burdon D. W., Alexander-Williams J., Keighley M. R. Influence of bowel preparation and antimicrobials on colonic microflora. Br J Surg. 1978 Aug;65(8):555–558. doi: 10.1002/bjs.1800650809. [DOI] [PubMed] [Google Scholar]
  2. Barker K., Graham N. G., Mason M. C., De Dombal F. T., Goligher J. C. The relative significance of preoperative oral antibiotics, mechanical bowel preparation, and preoperative peritoneal contamination in the avoidance of sepsis after radical surgery for ulcerative colitis and Crohn's disease of the large bowel. Br J Surg. 1971 Apr;58(4):270–273. [PubMed] [Google Scholar]
  3. Bornside G. H., Cohn I., Jr Intestinal antisepsis. Stability of fecal flora during mechanical cleansing. Gastroenterology. 1969 Nov;57(5):569–573. [PubMed] [Google Scholar]
  4. Byrne B. M., Dankert J. Volatile fatty acids and aerobic flora in the gastrointestinal tract of mice under various conditions. Infect Immun. 1979 Mar;23(3):559–563. doi: 10.1128/iai.23.3.559-563.1979. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Clarke J. S., Condon R. E., Bartlett J. G., Gorbach S. L., Nichols R. L., Ochi S. Preoperative oral antibiotics reduce septic complications of colon operations: results of prospective, randomized, double-blind clinical study. Ann Surg. 1977 Sep;186(3):251–259. doi: 10.1097/00000658-197709000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Gorbach S. L., Neale G., Levitan R., Hepner G. W. Alterations in human intestinal microflora during experimental diarrhoea. Gut. 1970 Jan;11(1):1–6. doi: 10.1136/gut.11.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Hewitt J., Reeve J., Rigby J., Cox A. G. Whole-gut irrigation in preparation for large-bowel surgery. Lancet. 1973 Aug 18;2(7825):337–340. doi: 10.1016/s0140-6736(73)93189-9. [DOI] [PubMed] [Google Scholar]
  8. Hollender L. F., Calderoli H., Philippides J., Jamart J. Advantages of whole gut irrigation in colorectal surgery. Curr Surg. 1980 Jul-Aug;37(4):227–233. [PubMed] [Google Scholar]
  9. Huk I., Starlinger M., Schiessel R., Wewalka G., Rotter M. Orthograde Darmspülung zur präoperativen Darmvorbereitung. Reduktion der Darmflora durch Antibioticazusatz. Chirurg. 1980 Feb;51(2):106–109. [PubMed] [Google Scholar]
  10. Longstreth G. F., Newcomer A. D. Drug-induced malabsorption. Mayo Clin Proc. 1975 May;50(5):284–293. [PubMed] [Google Scholar]
  11. McGowan K., Gorbach S. L. Anaerobes in mixed infections. J Infect Dis. 1981 Aug;144(2):181–186. doi: 10.1093/infdis/144.2.181. [DOI] [PubMed] [Google Scholar]
  12. Nichols R. L., Condon R. E., Gorbach S. L., Nyhus L. M. Efficacy of preoperative antimicrobial preparation of the bowel. Ann Surg. 1972 Aug;176(2):227–232. doi: 10.1097/00000658-197208000-00019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Onderdonk A. B., Bartlett J. G., Louie T., Sullivan-Seigler N., Gorbach S. L. Microbial synergy in experimental intra-abdominal abscess. Infect Immun. 1976 Jan;13(1):22–26. doi: 10.1128/iai.13.1.22-26.1976. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Preventing infection at the operation site. Br Med J. 1976 Oct 2;2(6039):773–774. doi: 10.1136/bmj.2.6039.773. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Stock W., Hirt H. J., Schaal K. P., Pichlmaier H. Die präoperative Darmkeimverminderung durch orthograde Dickdarmspülung. Chirurg. 1977 Mar;48(3):161–165. [PubMed] [Google Scholar]
  16. Welling G. W., Groen G. beta-Aspartylglycine, a substance unique to caecal contents of germ-free and antibiotic-treated mice. Biochem J. 1978 Dec 1;175(3):807–812. doi: 10.1042/bj1750807. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Wensinck F., Ruseler-van Embden J. G. The intestinal flora of colonization-resistant mice. J Hyg (Lond) 1971 Sep;69(3):413–421. doi: 10.1017/s0022172400021665. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. van den Bogaard A. E., Hazen M. J., Van Boven C. P. Quantitative gas chromatographic analysis of volatile fatty acids in spent culture media and body fluids. J Clin Microbiol. 1986 Mar;23(3):523–530. doi: 10.1128/jcm.23.3.523-530.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. van der Waaij D., Berghuis-de Vries J. M., Lekkerkerk Lekkerkerk-v Colonization resistance of the digestive tract in conventional and antibiotic-treated mice. J Hyg (Lond) 1971 Sep;69(3):405–411. doi: 10.1017/s0022172400021653. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from The Journal of Hygiene are provided here courtesy of Cambridge University Press

RESOURCES