Long-term implications of using preoperative oral antibiotics to prevent surgical-site infections in colon surgery: a follow-up study from ORALEV RCT.

Publication date: Jun 01, 2026

ORALEV-RCT demonstrated that preoperative oral antibiotics (OA) before colon surgery reduces surgical-site infections. There was concern regarding a potential risk of antibiotic resistance. To assess if OA led to increased long-term infection-related complications/antibiotic resistance. Retrospective analysis of 3-year follow-up data of ORALEV. risk of infectious complications with vs without OA. Secondary: long-term complications, effect on COVID-19. 529 were included (n = 265,no OA vs n = 264,OA). Infective complications with hospital admissions (2. 6% vs 2. 6%, no OA vs OA), antibiotic treatment (1. 9% vs 1. 1%,p = 0. 715), and COVID-19 (0. 4% vs 1. 5%,p = 0. 22) did not differ. Three patients required ertapenem. Readmissions for any complication did not differ (10. 9% vs 12. 5%,p = 0. 67). After removing COVID-19 admissions, COPD was associated with need for antibiotic treatment in the long-term (HR 5. 13, 95%CI 1. 28-20. 54) irrespective of OA administration. Postoperative hernia (4. 1% vs 1. 5%,p = 0. 11) and indication for repair (81. 8% vs 25%,p = 0. 08) were higher in non-OA group, but not statistically different. OA do not increase the risk of long-term infective complications and need for advanced antimicrobial treatment. COPD increased the risk of subsequent need for antibiotic treatment.

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