A comparison of postprocedural wound care treatments: Do antibiotic-based ointments improve outcomes?

Draelos, Zoe Diana; Rizer, Ronald L.; Trookman, Nathan S.

doi:10.1016/j.jaad.2010.11.010

Cited by 66 publications

(47 citation statements)

References 34 publications

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“…Since most wound infections occur as a result of contamination before wound closure, administering topical antibiotics postoperatively is not an effective measure to prevent postsurgical wound infections (34). The rates of postsurgical wound infection in the modern-day outpatient dermatologic setting are low, typically ranging from 0.7% to 4.0% (12)(13)(14)(15)18,21,23,27,28,31,32,(35)(36)(37)(38) even without prophylactic antibiotics secondary to current aseptic practices, such as preoperative surgical site preparation, sterilization of instruments and wearing gloves (4,22,(39)(40)(41). Furthermore, most of the wound infections that develop in this setting are mild and easily treated, frequently with basic wound care management alone and no antibiotics (34).…”

Section: Discussionmentioning

confidence: 99%

“…Topical antibiotics are frequently used for surgical wound infection prophylaxis, as this route of administration achieves high local drug concentrations without inducing significant systemic effects (3). Various dermatologic procedures performed in an office setting, ranging from skin biopsies to Mohs surgery, lead to the creation of a superficial skin wound, for which topical antibiotics are frequently prescribed to reduce risk of infection (4). Dermatologists prescribe more antibiotics to patients than physicians in any other medical specialty in USA.…”

Section: Introductionmentioning

confidence: 99%

“…Dermatologists prescribe more antibiotics to patients than physicians in any other medical specialty in USA. In 2003 alone, dermatologists wrote three to four million prescriptions for topical antibiotics (4)(5)(6). The perceived benefits of topical antibiotics stem not only from their antimicrobial effects, but also from the moist environment provided by antibacterial ointments (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Topical antibiotic prophylaxis for prevention of surgical wound infections from dermatologic procedures: a systematic review and meta-analysis

Saco

Howe

Nathoo

et al. 2014

Journal of Dermatological Treatment

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Topical antibiotic prophylaxis for prevention of surgical wound infections from dermatologic procedures: a systematic review and meta-analysis

Saco

Howe

Nathoo

et al. 2014

Journal of Dermatological Treatment

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“…6,10 Bacitracin as an ointment has been associated with wound irritation and some increase in wound breakdown. 12 Nephrotoxicity has also rarely been reported when used via the intramuscular route.…”

mentioning

confidence: 99%

Reduction in CSF shunt infection over a 10-year period associated with the application of concentrated topical antibiotic powder directly to surgical wounds prior to closure

Beckman

Amankwah²,

Tetreault

et al. 2015

PED

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OBJECT The application of concentrated topical antibiotic powder directly to surgical wounds has been associated with a reduction in wound infection in cardiac, spinal, and deep brain stimulator surgery. As a result of these findings, the corresponding author began systematically applying concentrated bacitracin powder directly to wounds during shunt surgery more than 5 years ago. The object of this study was to evaluate the effectiveness of concentrated bacitracin powder applied directly to wounds prior to closure during cranial shunt surgery and to evaluate the association between shunt infection and other risk factors. A single surgeon’s cranial shunt surgery experience, equally divided between periods during which antibiotic powder was and was not applied, was studied to assess the effect of concentrated bacitracin powder application on shunt infection rates. METHODS This retrospective cohort study included all patients who underwent a cranial shunting procedure at All Children’s Hospital performed by a single surgeon (G.F.T.) from 2001 to 2013. The surgeon applied bacitracin powder to all shunt wounds prior to closure between 2008 and 2013, whereas no antibiotic powder was applied to wounds prior to 2008. Both initial and revision shunting procedures were included, and all procedures were performed at a large children’s hospital (All Children’s Hospital). The primary outcome measure was shunt infection, which was defined using clinical criteria previously used by the Hydrocephalus Clinical Research Network. The association between bacitracin powder use and shunt infection was estimated using hazard ratios (HRs) and 95% CIs from Cox proportional hazard regression models. RESULTS A total of 47 infections out of 539 shunt operations occurred during the study period, resulting in an overall infection rate of 8.7%. Procedures performed before the use of concentrated bacitracin powder was instituted resulted in a 13% infection rate, whereas procedures performed after systematic use of bacitracin powder had been adopted experienced a 1% infection rate. Bacitracin powder use was associated with a reduced risk of shunt infection in univariate analysis (HR 0.11, 95% CI 0.03–0.34, p = 0.0002) and also in multivariate analysis (HR 0.12, 95% CI 0.04–0.41, p = 0.0006) when controlling for covariates that were associated with infection from the univariate analysis. The presence of a tracheostomy or a gastrostomy tube was also found to be independently associated with shunt infection in multivariate analysis (HR 3.15, 95% CI 1.05–9.50, p = 0.04, and HR 2.82, 95% CI 1.33–5.96, p = 0.007, respectively). CONCLUSIONS This study suggests, for the first time, that the systematic application of concentrated bacitracin powder to surgical wounds prior to closure during shunt surgery may be associated with a reduction in cranial shunt infection. This initial finding requires validation in a large prospective study before widespread application can be advocated.

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“…[1][2][3]5,6,[10][11][12]14,15,21,22,24,25,[27][28][29] Our group's recent 10-year retrospective study showed that the application of bacitracin antibiotic powder to wounds during CSF shunt surgery was associated with a reduction in shunt infection rates.4 Briefly, two separate 5-year periods in which bacitracin was and was not systematically applied to shunt wounds were analyzed using both univariate and multivariate analyses. Independent abbreviations eGFR = estimated glomerular filtration rate; HR = hazard ratio.…”

mentioning

confidence: 99%

Complications associated with bacitracin powder in surgical wounds

Beckman¹,

Amankwah

Tetreault

et al. 2015

PED

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T opical antibiotics have been used in many surgical subspecialties in an attempt to minimize wound infection with mixed results. [1][2][3]5,6,[10][11][12]14,15,21,22,24,25,[27][28][29] Our group's recent 10-year retrospective study showed that the application of bacitracin antibiotic powder to wounds during CSF shunt surgery was associated with a reduction in shunt infection rates. 4 Briefly, two separate 5-year periods in which bacitracin was and was not systematically applied to shunt wounds were analyzed using both univariate and multivariate analyses. Independent abbreviations eGFR = estimated glomerular filtration rate; HR = hazard ratio. obJect There has been renewed interest in the application of concentrated antibiotic powder to surgical wounds as a method to decrease infection rates. While there is substantial medical literature describing the effectiveness and complications associated with vancomycin and gentamycin powders, very little has been reported regarding the safety and effectiveness of bacitracin powder in surgical wounds. In this paper the authors report their detailed analysis of potential bacitracin powder-related complications in a population of pediatric patients who underwent shunt surgery. methods A detailed retrospective analysis was completed of all CSF shunt surgeries performed by the corresponding author at a large children's hospital between 2001 and 2013. This cohort consisted of many patients who were the subject of a previous report that showed the use of bacitracin powder in shunt wounds potentially decreased infection rates. Data were collected regarding the most common known complications of bacitracin, i.e., anaphylaxis, wound healing difficulties, and renal dysfunction. Data were stratified by typical demographic, medical, and surgical variables, including whether bacitracin powder was applied to wounds prior to closure. results A total of 597 patients were reviewed in the analysis: 389 underwent surgery without bacitracin powder and 208 had concentrated bacitracin powder applied to the wounds prior to closure. The application of bacitracin powder was not associated with anaphylaxis (n = 0 both groups) or with an increase in wound breakdown (n = 5 in the control group, n = 0 in the bacitracin powder group) or renal dysfunction (creatinine/estimated glomerular filtration rate) using both comparative and multivariate analyses between the 2 groups. The sample size evaluating renal function was significantly lower (range 6-320) than that of anaphylaxis and wound breakdown analysis because only clinical values acquired during the routine care of these patients were available for analysis. The only significant difference in demographics was the more frequent use of intrathecal vancomycin and gentamycin in patients who received bacitracin powder (n = 1 for controls, n = 21 for bacitracin powder). In the multivariate analysis, only 1 factor, surgery performed on a premature infant within the first 3 months of life, was independently associated with a change in creatinine at 3 mont...

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A comparison of postprocedural wound care treatments: Do antibiotic-based ointments improve outcomes?

Cited by 66 publications

References 34 publications

Topical antibiotic prophylaxis for prevention of surgical wound infections from dermatologic procedures: a systematic review and meta-analysis

Topical antibiotic prophylaxis for prevention of surgical wound infections from dermatologic procedures: a systematic review and meta-analysis

Reduction in CSF shunt infection over a 10-year period associated with the application of concentrated topical antibiotic powder directly to surgical wounds prior to closure

Complications associated with bacitracin powder in surgical wounds

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