Role of intraoperative wound irrigation with antibiotics in reducing surgical site infection in patients undergoing contaminated and dirty midline laparotomy surgical wound: a pilot study

Authors

  • Sandhiya P. Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
  • Sureshkumar S. Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
  • Vijayakumar C. Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
  • Palanivel C. Department of PSM, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India

DOI:

https://doi.org/10.18203/2349-2902.isj20182780

Keywords:

Antiseptic, Laparotomy, Morbidity, Quality of life, Surgical site infection, Wound irrigation

Abstract

Background: This study was carried to assess the effect of antibiotic wound irrigation in reducing the surgical site infection (SSI) in the patients undergoing midline laparotomy with contaminated and dirty surgical incision wound.

Methods: All patients operated with class-IV- dirty and class III (contaminated) abdominal operative wound according to CDC (Centre for Disease Control and Prevention) were included in this pilot study. Study patients were divided into antibiotic irrigation group and control group. In control group, after rectus sheath closure, the wound was irrigated with 100 mL of normal saline before the skin closure. In antibiotic irrigation group, after rectus sheath closure, the wound was irrigated with Ceftriaxone (10 mL) and Metronidazole (100 mL). Incidence of SSI, degree of SSI and length of hospitalization were compared between two groups.

Results: A total of 40 patients were included in the study, 20 in each group. Both the groups were comparable with respect the age, gender, co-morbidities and class of surgical wound. The incidence of SSI was lesser [10% versus 35%; p=0.06] in the antibiotic irrigation group compared to control group. However, the difference was not statistically significant. The length of hospitalization between the groups were comparable [13.5 versus 14.7 days; p=0.74]. The pain score was also not significantly different between the two groups.

Conclusions: On comparing to saline irrigation, antibiotic irrigation in patients with contaminated and dirty operative wound results in a lesser SSI with comparable hospital stay and postoperative pain. However, the difference was not statistically significant.

 

References

Cruse PJE, Foord R. The epidemiology of wound infection. Surg Clin North Am. 1980;60:27-40.

Garibaldi RA, Cushing D, Lerer T. Risk factors for postoperative infection. Am J Med. 1991;91:158-63.

Riou J-P A, Cohen JR, Johnson H. Factors influencing wound dehiscence. Am J Surg. 1992;163:324-30.

Wittmann DH. Intraabdominal infections- introduction. World J Surg. 1990;14:145-7.

Aprahamian C, Schein M, Wittmann D. Cefotaxime and metronidazole in severe intra-abdominal infection. Diagn Microbiol Infect Dis. 1995;2:183-8.

Mosdell DM, Morris DM, Voltura A, Pitcher DE, Twiest MW, Milne RL et al. Antibiotic treatment for surgical peritonitis. Ann Surg. 1991;214:543-9.

Stone HH, Strom PR, Fabian TC, Dunlop WE. Third-generation cephalosporins for polymicrobial surgical sepsis. Arch Surg. 1983;118:193-200.

Krepel CJ, Gohr CM, Edmiston CE, Condon RE. Surgical sepsis: constancy of antibiotic susceptibility of causative organisms. Surgery. 1995;117:505-9.

Parcells JP, Mileski JP, Gnagy FT, Haragan AF, Mileski WJ. Using antimicrobial solution for irrigation in appendicitis to lower surgical site infection rates. Am J Surg. 2009;198(6):875-80.

Barnes S, Spencer M, Graham D, Johnson HB. Surgical wound irrigation: a call for evidence-based standardization of practice. Am J Infect Control. 2014;42(5):525-9.

Muller TC, Martin L, Haller B, Mihaljevic AL, Nitsche U, Wilhelm D et al. Intra-operative wound irrigation to reduce surgical site infections after abdominal surgery: a systematic review and meta-analysis. Langenbecks Arch Surg. 2015;400:167-81.

Alfonso JL, Pereperez SB, Canoves JM, Martinez MM, Martinez IM, Martin-Moreno JM. Are we really seeing the total costs of surgical site infection? A Spanish study. Wound Repair Regen. 2007;15(4):474-8.

Downloads

Published

2018-06-25

Issue

Section

Original Research Articles