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      Antimicrobial prophylaxis in colorectal surgery: focus on ertapenem

      Therapeutics and Clinical Risk Management

      Dove Medical Press

      colorectal surgery, surgical prophylaxis, ertapenem

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          Abstract

          Despite improvement in infection control measures and surgical practice, surgical site infections (SSIs) remain a major cause of morbidity and mortality. In colorectal surgery, perioperative administration of a suitable antimicrobial regimen that covers both anaerobic and aerobic bacteria is universally accepted. In a prospective, double-blind, randomized study ertapenem was recently found to be more effective than cefotetan, a parenteral cephalosporin so broadly used as to be considered as gold standard in the prevention of SSIs following colorectal surgery. In this adequate and well controlled study, the superiority of ertapenem over cefotetan was clearly demonstrated from the clinical and bacteriological points of view. However, data that directly compares ertapenem with other antimicrobial regimen effective in preventing SSIs following colorectal surgery are lacking; furthermore, the possible risk of promotion of carbapenem resistance associated with widespread use of ertapenem prophylaxis as well as the ertapenem effects on the intestinal gut flora are of concern. Further comparative studies of ertapenem versus other widely used prophylactic regimens for colorectal surgery in patients submitted to mechanical bowel preparation versus no preparation as well as further research on adverse events of antibiotic prophylaxis, including emergence of resistance and Clostridium difficile infection, seem warranted.

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          Author and article information

          Journal
          Ther Clin Risk Manag
          Therapeutics and Clinical Risk Management
          Therapeutics and Clinical Risk Management
          Dove Medical Press
          1176-6336
          1178-203X
          2009
          2009
          2 November 2009
          : 5
          : 829-839
          Affiliations
          Libero Docente of Infectious Diseases, University of Milano, Milano, Italy
          Author notes
          Correspondence: Fausto de Lalla, viale Milano 27, 36100 Vicenza, Italy, Tel +39 337 487 470, Email faustodelalla@ 123456alice.it
          Article
          tcrm-5-829
          2773751
          19898647
          © 2009 de Lalla, publisher and licensee Dove Medical Press Ltd.

          This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

          Categories
          Review

          Medicine

          ertapenem, surgical prophylaxis, colorectal surgery

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