Oral neomycin and bacitracin are effective in preventing surgical site infections in elective colorectal surgery: a multicentre, randomized, parallel, single-blinded trial (COLORAL-1).

Several regimens of oral and intravenous antibiotics (OIVA) have been proposed with contradicting results, and the role of mechanical bowel preparation (MBP) is still controversial. This study aims to assess the effectiveness of oral antibiotic prophylaxis in preventing Surgical Site Infections (SSI) in elective colorectal surgery. In a multicentre trial, we randomized patients undergoing elective colorectal resection surgery, comparing the effectiveness of OIVA versus intravenous antibiotics (IVA) regimens to prevent SSI as the primary outcome (NCT04438655). In addition to intravenous Amoxicillin/Clavulanic, patients in the OIVA group received Oral Neomycin and Bacitracin 24 h before surgery. MBP was administered according to local habits which were not changed for the study. The trial was terminated during the COVID-19 pandemic, as many centers failed to participate as well as the pandemic changed the rules for engaging patients. Two-hundred and four patients were enrolled (100 in the OIVA and 104 in the IVA group); 3 SSIs (3.4%) were registered in the OIVA and 14 (14.4%) in the IVA group (p = 0.010). No difference was observed in terms of anastomotic leak. Multivariable analysis indicated that OIVA reduced the rate of SSI (OR 0.21 / 95% CI 0.06-0.78 / p = 0.019), while BMI is a risk factor of SSI (OR 1.15 / 95% CI 1.01-1.30 p = 0.039). Subgroup analysis indicated that 0/22 patients who underwent OIVA/MBP + vs 13/77 IVA/MBP- experienced an SSI (p = 0.037). The early termination of the study prevents any conclusion regarding the interpretation of the data. Nonetheless, Oral Neomycin/Bacitracin and intravenous beta-lactam/beta-lactamases inhibitors seem to reduce SSI after colorectal resections, although not affecting the anastomotic leak in this trial. The role of MBP requires more investigation.

[Pyogenic abscess in hepatic metastasis: unusual first manifestation of colorectal cancer. A case report]. / Metastasi ascessualizzata del fegato: insolita presentazione clinica del cancro colon-rettale. Caso clinico.

Pyogenic liver abscesses and colorectal cancer are rarely reported in association. Necrosis and infection of hepatic metastases from colorectal cancer are rare events which occur in the absence of systemic or local therapy. We report a case of a 72-year-old woman with a four day history of high fever, abdominal pain and a palpable mass in the right upper quadrant. Ultrasonography and CT scan showed a 13-cm solitary abscess in hepatic segment V-VI with multiple satellite metastases. For suspected imminent rupture into the peritoneal cavity a surgical drain was performed. Colorectal cancer was discovered during abdominal exploration and a colon resection was performed two weeks later. The search for the underlying cause of the pyogenic liver abscess should be an integral part of the correct management of liver abscesses. Association with a colorectal cancer is rare but should be taken into consideration.