{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T11:09:56Z","timestamp":1790248196241,"version":"4.1.0"},"reference-count":32,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Surgical site infection (SSI) remains a common complication after ileostomy closure. Mechanical bowel preparation (MBP) and oral antibiotic preparation are often bundled together, so their independent contributions to SSI risk are unclear. We evaluated the adjusted associations of oral antibiotic preparation and MBP with SSI after ileostomy closure, a setting in which these two components have rarely been examined separately. Methods: We retrospectively reviewed 432 consecutive patients undergoing loop or end ileostomy closure at a single center between January 2022 and December 2025. SSI was defined per Centers for Disease Control and Prevention\/National Healthcare Safety Network (CDC\/NHSN) criteria. Multivariable logistic regression was used to assess adjusted associations with SSI, with MBP and oral antibiotic preparation included as the exposures of primary interest, adjusting for adjuvant oncologic therapy and closed suction drain use\u2014the covariates associated with SSI on univariate analysis. Results: SSI occurred in 35 patients (8.1%). Oral antibiotic preparation was associated with a lower SSI rate (2.9% vs. 11.5% without; absolute risk reduction 8.5 percentage points, unadjusted descriptive number needed to treat 12; p = 0.003), while no statistically significant unadjusted association was detected for MBP (p = 1.000). After adjustment, oral antibiotic preparation was associated with lower odds of SSI (odds ratio [OR], 0.21; 95% confidence interval [CI], 0.08\u20130.56; p = 0.002), whereas no statistically significant adjusted association was observed for MBP (OR, 1.21; 95% CI, 0.58\u20132.53; p = 0.610); this confidence interval is compatible with both a clinically meaningful benefit and a clinically meaningful harm of MBP, and the study is not powered to exclude either. Adjuvant oncologic therapy (OR 2.53, 95% CI 1.23\u20135.20) and closed suction drain use (OR 2.33, 95% CI 1.14\u20134.77) were associated with higher adjusted odds of SSI. The model showed acceptable discrimination (area under the receiver operating characteristic curve [AUC] = 0.745), with no evidence of poor fit on a covariate-pattern-based goodness-of-fit assessment (\u03c72 = 11.37, df = 14, p = 0.657). A Firth penalized-likelihood model, used because of the limited number of events in the antibiotic-exposed group, gave materially unchanged estimates (OR 0.23, 95% CI 0.09\u20130.58). Conclusions: Oral antibiotic preparation was associated with lower adjusted odds of SSI after ileostomy closure, whereas the association with MBP remained inconclusive. This observational association should not be interpreted as evidence of causality, because residual confounding\u2014particularly by surgeon-level practice\u2014cannot be excluded. These findings should be considered hypothesis-generating and require confirmation in prospective studies using standardized preparation protocols.<\/jats:p>","DOI":"10.3390\/jcm15197436","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T10:16:28Z","timestamp":1790244988000},"page":"7436","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Oral Antibiotic Preparation Is Associated with Lower Surgical Site Infection After Ileostomy Closure: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"given":"\u0130smail Ege","family":"Suba\u015f\u0131","sequence":"first","affiliation":[{"name":"Department of General Surgery, Sancaktepe \u015eehit Prof. Dr. \u0130lhan Varank Training and Research Hospital, University of Health Sciences, Istanbul 34785, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmet","family":"Topcu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Sancaktepe \u015eehit Prof. Dr. \u0130lhan Varank Training and Research Hospital, University of Health Sciences, Istanbul 34785, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9288-0993","authenticated-orcid":false,"given":"Furkan","family":"Sayd\u0131n","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Sancaktepe \u015eehit Prof. Dr. \u0130lhan Varank Training and Research Hospital, University of Health Sciences, Istanbul 34785, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1159\/000354426","article-title":"Prevalence of surgical site infection at the stoma site following four skin closure techniques: A retrospective cohort study","volume":"31","author":"Li","year":"2014","journal-title":"Dig. Surg."},{"key":"ref_2","first-page":"CD014763","article-title":"Purse-string skin closure versus linear skin closure in people undergoing stoma reversal","volume":"3","author":"Hajibandeh","year":"2024","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1097\/DCR.0000000000000401","article-title":"Pursestring closure versus conventional primary closure following stoma reversal to reduce surgical site infection rate: A meta-analysis of randomized controlled trials","volume":"58","author":"Hsieh","year":"2015","journal-title":"Dis. Colon Rectum"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1111\/codi.12556","article-title":"Circular closure is associated with the lowest rate of surgical site infection following stoma reversal: A systematic review and multiple treatment meta-analysis","volume":"16","author":"Li","year":"2014","journal-title":"Colorectal Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1002\/bjs.7151","article-title":"Randomized clinical trial of short-term outcomes following purse-string versus conventional closure of ileostomy wounds","volume":"97","author":"Reid","year":"2010","journal-title":"Br. J. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Anestiadou, E., Stamiris, S., Ioannidis, O., Symeonidis, S., Bitsianis, S., Bougioukas, K., Karagiannis, T., Kotidis, E., Pramateftakis, M.-G., and Mantzoros, I. (2025). Comparison of negative pressure wound therapy systems and conventional non-pressure dressings on surgical site infection rate after stoma reversal: Systematic review and meta-analysis of randomized controlled trials. J. Clin. Med., 14.","DOI":"10.20944\/preprints202501.1941.v1"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s10151-020-02372-w","article-title":"Prophylactic negative-pressure wound therapy after ileostomy reversal for the prevention of wound healing complications in colorectal cancer patients: A randomized controlled trial","volume":"25","author":"Wierdak","year":"2021","journal-title":"Tech. Coloproctol."},{"key":"ref_8","first-page":"e41708","article-title":"The use of 2-octylcyanoacrylate dressing in reducing the risk of superficial surgical site infections in colorectal stoma surgery: A retrospective cohort study","volume":"15","author":"Bukhari","year":"2023","journal-title":"Cureus"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e183226","DOI":"10.1001\/jamanetworkopen.2018.3226","article-title":"Association of mechanical bowel preparation and oral antibiotics before elective colorectal surgery with surgical site infection: A network meta-analysis","volume":"1","author":"Toh","year":"2018","journal-title":"JAMA Netw. Open"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/SLA.0000000000003145","article-title":"The role of oral antibiotic preparation in elective colorectal surgery: A meta-analysis","volume":"270","author":"Rollins","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1177\/000313481608200941","article-title":"Preoperative bowel preparation before elective bowel resection or ostomy closure in the pediatric patient population has no impact on outcomes: A prospective randomized study","volume":"82","author":"Shah","year":"2016","journal-title":"Am. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1016\/j.jpedsurg.2022.09.003","article-title":"Is colostomy closure without mechanical bowel preparation safe in pediatric patients? A randomized clinical trial","volume":"58","year":"2023","journal-title":"J. Pediatr. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2667","DOI":"10.1007\/s11605-023-05803-9","article-title":"Comparison of enhanced recovery after surgery (ERAS) pathway versus standard care in patients undergoing elective stoma reversal surgery: A randomized controlled trial","volume":"27","author":"Madan","year":"2023","journal-title":"J. Gastrointest. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"100277","DOI":"10.1016\/j.sipas.2025.100277","article-title":"Surgical site infection reduction bundle in stoma closure: A retrospective cohort study","volume":"20","author":"Goto","year":"2025","journal-title":"Surg. Pract. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Hosmer, D.W., Lemeshow, S., and Sturdivant, R.X. (2013). Applied Logistic Regression, John Wiley & Sons. [3rd ed.].","DOI":"10.1002\/9781118548387"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Li, S., Zhou, Z., Wang, F., Li, W., Liu, C., and Li, L. (2025). Risk factors and incidence of surgical wound infection after stoma reversal: A systematic review and meta-analysis. PLoS ONE, 20.","DOI":"10.1371\/journal.pone.0336704"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s00384-024-04786-6","article-title":"Development of a novel nomogram for the prediction of surgical site infection risk after loop ileostomy closure","volume":"39","author":"Hu","year":"2024","journal-title":"Int. J. Colorectal Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"5198","DOI":"10.1007\/s00464-025-11887-y","article-title":"Higher BMI increases risk of stoma-site incisional hernia and other complications following diverting loop ileostomy and reversal: A systematic review and meta-analysis","volume":"39","author":"Sadiq","year":"2025","journal-title":"Surg. Endosc."},{"key":"ref_20","first-page":"24","article-title":"The role of obesity in the patient undergoing colorectal surgery and fecal diversion: A review of the literature","volume":"60","author":"Colwell","year":"2014","journal-title":"Ostomy Wound Manag."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1007\/s11605-014-2649-3","article-title":"Surgical site infections (SSIs) after stoma reversal (SR): Risk factors, implications, and protective strategies","volume":"19","author":"Chu","year":"2015","journal-title":"J. Gastrointest. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Xu, Z., Qu, H., Gong, Z., Kanani, G., Zhang, F., Ren, Y., Shao, S., Chen, X., and Chen, X. (2021). Risk factors for surgical site infection in patients undergoing colorectal surgery: A meta-analysis of observational studies. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0259107"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1097\/DCR.0000000000003450","article-title":"The American Society of Colon and Rectal Surgeons clinical practice guidelines for preventing surgical site infection","volume":"67","author":"Shogan","year":"2024","journal-title":"Dis. Colon Rectum"},{"key":"ref_24","first-page":"e75407","article-title":"Risk factors for anastomotic leakage following stoma closure: A retrospective study in tertiary hospitals in Yemen","volume":"16","author":"Obadiel","year":"2024","journal-title":"Cureus"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2147","DOI":"10.1007\/s00384-020-03706-8","article-title":"Update on risk factors of surgical site infection in colorectal cancer: A systematic review and meta-analysis","volume":"35","author":"Xu","year":"2020","journal-title":"Int. J. Colorectal Dis."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Calu, V., Piriianu, C., Miron, A., and Grigorean, V.T. (2024). Surgical site infections in colorectal cancer surgeries: A systematic review and meta-analysis of the impact of surgical approach and associated risk factors. Life, 14.","DOI":"10.3390\/life14070850"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1186\/s13756-019-0547-x","article-title":"Gender-related risk factors for surgical site infections. Results from 10 years of surveillance in Germany","volume":"8","author":"Aghdassi","year":"2019","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Liu, B., Ye, J., Sun, W., Yang, Y., Zhu, J., and Zhao, S. (2025). Role of wound protectors in preventing surgical site infection in patients undergoing abdominal surgery: A meta-analysis of randomized controlled trials. BMC Surg., 25.","DOI":"10.1186\/s12893-025-02809-9"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"104656","DOI":"10.1016\/j.amsu.2022.104656","article-title":"Role of single or double ringed circumferential wound protectors in reducing surgical site infections following colorectal resections. A systematic review","volume":"82","author":"Nour","year":"2022","journal-title":"Ann. Med. Surg."},{"key":"ref_30","first-page":"97","article-title":"Povidone-iodine irrigation of subcutaneous tissues may decrease surgical site infections in elective colorectal operations: A systematic review","volume":"4","author":"Gill","year":"2011","journal-title":"Gastroenterol. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1097\/SLA.0000000000005786","article-title":"Aqueous povidone-iodine versus normal saline for intraoperative wound irrigation on the incidence of surgical site infection in clean-contaminated wounds after gastroenterological surgery: A single-institute, prospective, blinded-endpoint, randomized controlled trial","volume":"277","author":"Maemoto","year":"2023","journal-title":"Ann. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1001\/jamasurg.2023.7985","article-title":"Intraoperative wound irrigation for the prevention of surgical site infection after laparotomy: A randomized clinical trial by CHIR-Net","volume":"159","author":"Mueller","year":"2024","journal-title":"JAMA Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7436\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T10:37:07Z","timestamp":1790246227000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7436"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,24]]},"references-count":32,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["jcm15197436"],"URL":"https:\/\/doi.org\/10.3390\/jcm15197436","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,24]]}}}