A randomized controlled trial was undertaken to compare the role of
mezlocillin, as the sole prophylactic agent, with a combination of
cefuroxime and
metronidazole in patients undergoing biliary and gastrointestinal surgery. No difference in
wound infection rates was seen in patients following appendicectomy, biliary or gastro-oesophageal surgery. A significantly higher
wound infection rate was seen in patients undergoing colorectal surgery who received
mezlocillin alone (30.2%) compared with those receiving
cefuroxime and
metronidazole (11.5%): this rate was similar to that of historical placebo controls in other units. The
wound infections seen in patients receiving
mezlocillin alone were polymicrobial involving organisms of faecal origin, including non-sporing anaerobes which were predominantly sensitive to
mezlocillin.
Infections due to Staphylococcus aureus, resistant to
mezlocillin, were more frequent in patients receiving
mezlocillin and usually secondary in nature. We conclude that
mezlocillin may be an effective sole prophylactic agent in appendicectomy but not in colorectal surgery; the possible reasons for failure to adequately prevent
infection, following colorectal surgery, are discussed.