Chlorhexidine Lavage in the Treatment of Experimental Intra-abdominal Infection

Abstract

Hypothesis: Closed postoperative peritoneal lavage (CPPL) with chlorhexidine gluconate reduces the number of intraperitoneal bacteria and improves the outcome of intra-abdominal infection. Design: Laboratory animal trial. Interventions: Intra-abdominal infection was produced in mice by the cecal ligation and puncture technique. After 16 to 18 hours, the animals underwent relaparotomy and placement of an intra-abdominal catheter for CPPL. In the first experiment animals were randomly divided into 4 groups: no lavage (served as a control), CPPL with chlorhexidine, CPPL with cefoxitin, and CPPL with lactated Ringer solution (LR). Lavage was continued intermittently every 8 hours for 24 hours. All animals received systemic cefoxitin every 8 hours for 7 days. Mortality was recorded every 8 hours for 10 days. In the second experiment, animals were divided into 3 groups: no lavage (served as a control), CPPL with chlorhexidine, and CPPL with LR. Lavage was continued intermittently every 8 hours for 24 hours. The animals were killed 48 hours after reoperation. Bacterial counts from peritoneal fluid and biopsy specimens, as well as peritoneal white blood cell counts, were measured before and after lavage. Results: Closed postoperative peritoneal lavage with chlorhexidine reduced mortality from 71% in a control group to 37% (P = .003). There was no survival benefit in either the CPPL with cefoxitin (91% mortality) (P = .14)

Increased postoperative peritoneal adhesion formation after the treatment of experimental peritonitis with chlorhexidine

“…Recently, van Westreenen et al [14] reported increased adhesion formation in a standard peritoneal ischaemia model in rats after peritoneal lavage with solutions as compared with a control group. However, peritoneal lavage facilitates the removal of pus, necrotic tissue or any other adjuvant substances from the peritoneal cavity in peritonitis and is a routine practice for many surgeons [3,5]. Saline solution is thought to be safe under these circumstances and is used as a standard lavage solution in most cases.…”

“…The conglomerate of organs formed by dense adhesions was present in 60% of cases when gastric peritonitis was lavaged by chlorhexidine and in only Introduction Despite advancements in surgical and intensive care treatment, peritonitis still remains a life-threatening condition, with mortality as high as 30% [1]. The current treatment of peritonitis consists of (1) source control, (2) general resuscitation measures, (3) systemic antibiotic therapy and (4) mechanical reduction of bacterial inoculum [2][3][4][5]. Whether there is a need for peritoneal lavage in order to reduce bacterial counts and what solution is the best for this purpose is still a matter of debate.…”

Rifamycin Lavage in the Treatment of Experimental Intra-Abdominal Infection

“…In these studies, the value of the lavage with physiological solution or antiseptics such as chlorexidine or povidone-iodine solution is unclear [13,16]. Indeed, some prospective randomized studies produced favorable conclusions [17], while others did not show any benefit [18]. In our study we expected an effect of the rifamycin peritoneal lavage on the outcome, the microbiology, and the adhesion score.…”

The Effects of Various Scolicidal Agents on the Hepatopancreatic Biliary System

“…Chx-Glu has a low toxicity profile at therapeutic concentrations of 0.05% in animal models of peritonitis [34,35] and in the clinical setting [36]. Bondar et al [37] showed that the lavage with 0.05% Chx-Glu was effective and non-toxic in intraabdominal infection. 5-min application of 0.04% Chx-Glu was shown to be 100% effective min in vitro and in the treatment of the IPH [9].…”