Nichols et al¹ first demonstrated the effectiveness of adding oral antibiotics to mechanical bowel preparation in 1973, yet in this issue of JAMA Surgery, Vo and colleagues² are publishing a retrospective analysis demonstrating the efficacy of oral antibiotics in reducing superficial and deep space infections in left colon resections in 2017. Oral antibiotics are inexpensive and generally well tolerated. So why are we still addressing the issue? First, virtually all patients, at least in the United States, now receive appropriate prophylactic parenteral antibiotics in a timely fashion, something not necessarily true in 1973. Second, mechanical bowel preparation has evolved, including the use of isotonic polyethylene glycol preparations, and is even skipped completely by some surgeons. Third, minimally invasive procedures have reduced the number of wound infections. Fourth, an increasing understanding of the beneficial as well as deleterious effects of the colonic microbiome suggests that disrupting the colonic microbial ecology may have adverse effects ranging from the obvious, such as Clostridium difficile infection, to the less obvious, such as adverse effects with regard to anastomotic healing,³ and crosstalk between the microbial community within the intestine and the host’s immune system that in turn mediates host immune responses.⁴

Nichols 等人¹于 1973 年首次证明了在机械肠道准备中添加口服抗生素的有效性，但在本期JAMA Surgery中，Vo 及其同事²正在发布一项回顾性分析，证明口服抗生素在 2017 年减少左结肠切除术中浅层和深部空间感染的功效。口服抗生素价格低廉且通常耐受性良好。那么我们为什么还要解决这个问题呢？首先，几乎所有患者，至少在美国，现在都及时接受了适当的预防性肠外抗生素，这在 1973 年不一定是正确的。其次，机械肠道准备已经发展，包括使用等渗聚乙二醇制剂，并且是甚至被一些外科医生完全跳过。第三，微创手术减少了伤口感染的数量。第四，艰难梭菌感染不太明显，例如对吻合口愈合的不利影响³以及肠道内微生物群落与宿主免疫系统之间的串扰，进而介导宿主免疫反应。⁴