Cystoscopy with antibiotic irrigation during pelvic reconstruction and minimally invasive gynecologic surgery: A double‐blind randomized controlled trial

Slopnick, Emily; Henderson, Joseph W.; Chapman, Graham; Sheyn, David; El-Nashar, Sherif; Petrikovets, Andrey; Pollard, R.R.; Mangel, Jeffrey

doi:10.1002/nau.24499

Cited by 4 publications

(22 citation statements)

References 29 publications

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“…Seven RCTs [18][19][20][21][22][23][24] published between 2018 and 2021 were included. One study by Krahn et al 19 was a cluster randomized crossover trial.…”

Section: Methodsmentioning

confidence: 99%

“…Six studies were conducted at 1 centre 18,20-24 and 1 study was conducted across 28 centres in Canada and the Netherlands. 19 In 6 RCTs, patients were randomized, [18][19][20][21]23,24 and in 1 RCT, mastectomy pockets were randomized. 22 Across the 7 RCTs, [18][19][20][21][22][23][24] population sizes ranged from 40 to 19,603 and follow-up time ranged from 1 week to 606 days.…”

Section: Methodsmentioning

confidence: 99%

“…Of these potentially relevant articles, 44 publications were excluded for various reasons, and 13 publications met the inclusion criteria and were included in this report. These comprised 5 SRs, 6,14-17 7 RCTs, [18][19][20][21][22][23][24] and 1 evidence-based guideline reported in 2 publications. 25,26 Appendix 1 presents the PRISMA 27 flow chart of the study selection.…”

Section: Quantity Of Research Availablementioning

confidence: 99%

“…Across RCTs, included populations were patients undergoing breast reconstruction, 22 open appendectomy, 18 laparoscopic colectomy, 21 neurosurgical procedures, 23 benign gynecologic surgery, 24 nonemergent open pancreatoduodenectomy, 20 or cardiac implantable electronic device procedures. 19 The mean age ranged from 27.9 to 72.0 years across the RCTs.…”

Section: Patient Populationmentioning

confidence: 99%

“…19 The mean age ranged from 27.9 to 72.0 years across the RCTs. Two RCTs included only female patients, 22,24 2 RCTs did not specify gender, 20,21 1 RCT had a greater proportion of patients who were female, 18 1 RCT had a greater proportion of patients who were male. 23 One RCT 19 reported 33.9% patients who were female and did not specify gender for the remaining population.…”

Section: Patient Populationmentioning

confidence: 99%

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Antibiotic Solutions for Surgical Irrigation

Darvesh¹,

Butcher²

2022

cjht

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During surgery, wounds can be washed out, or irrigated, using antibiotic, antiseptic, or saline solutions to prevent infections; the evidence in this report found over 20 different antibiotic solutions used across trials. Most studies showed that antibiotic irrigation solutions were better or no different compared to using antiseptic, saline, or no irrigation; however, a small number of studies indicated otherwise. One study reported in a systematic review showed fewer infections and complications for antiseptic compared to a triple antibiotic solution, while another study included in the same systematic review found a higher percentage of implant loss when a triple antibiotic solution was compared to antiseptic; data were poorly reported in these studies. Bacitracin-specific evidence was found in 2 studies; 1 study reported in 1 systematic review showed a higher percentage of infection when bacitracin irrigation was compared to cefazolin and saline irrigation; however, this was not statistically significant. Another study showed no differences in infections requiring surgical intervention or in hospitalization when bacitracin irrigation was compared to no irrigation. One guideline recommends that wound irrigation and intracavity lavage should not be conducted during surgery, and that applying antibiotics before wound closure should only be done as part of a research trial. Due to the mixed findings across studies, high-quality research is needed to clarify the role of antibiotic irrigation during surgery. Because guideline recommendations about wound irrigation, specifically, are based on research published before 2008, updated guidelines to include research from more current studies are needed to reflect current practice.

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“…Seven RCTs [18][19][20][21][22][23][24] published between 2018 and 2021 were included. One study by Krahn et al 19 was a cluster randomized crossover trial.…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Quantity Of Research Availablementioning

confidence: 99%

Section: Patient Populationmentioning

confidence: 99%

Section: Patient Populationmentioning

confidence: 99%

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Antibiotic Solutions for Surgical Irrigation

Darvesh¹,

Butcher²

2022

cjht

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Antibiotic prophylaxis for surgical wound infections in clean and clean-contaminated surgery: an updated systematic review and meta-analysis

Tang,

Bin,

et al. 2024

International Journal of Surgery

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Background: The efficacy and necessity of prophylactic antibiotics in clean and clean-contaminated surgery remains controversial. Methods: The studies were screened and extracted using databases including PubMed, Embase, Cochrane Library, Web of Science, and Clinical Trials.gov according to predefined eligibility criteria. Randomized controlled trials (RCTs) comparing the effect of preoperative and postoperative prophylactic antibiotic use on the incidence of surgical site infections (SSIs) in patients undergoing any clean or clean-contaminated surgery. Results: A total of 16,189 participants in 48 RCTs were included in the primary meta-analysis following the eligibility criteria. The pooled odds ratio (OR) for SSI with antibiotic prophylaxis versus placebo was 0.60 (95% CI: 0.53-0.68). The pooled OR among gastrointestinal, oncology, orthopedics, neurosurgery, oral, and urology surgery was 3.06 (95% CI: 1.05-8.91), 1.16 (95% CI: 0.89-1.50), 2.04 (95% CI: 1.09-3.81), 3.05 (95% CI: 1.25-7.47), 3.55 (95% CI: 1.78-7.06), and 2.26 (95% CI: 1.12-4.55), respectively. Furthermore, the summary mean difference (MD) for patients’ length of hospitalization was -0.91 (95% CI: -1.61, -0.16). The results of sensitivity analyses for all combined effect sizes showed good stability. Conclusion: Antibiotics are both effective, safe, and necessary in preventing surgical wound infections in clean and clean-contaminated procedures, attributed to their reduction in the incidence of surgical site infections as well as the length of patient hospitalization.

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Intraoperative Gentamicin Intravesical Instillation for Prevention of Urinary Tract Infection After Urogynecologic Surgery: A Randomized Controlled Trial

Rieger

Shah

Ferrante

et al. 2022

UROGC

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Importance Currently available evidence for efficacy of postoperative antibiotics to prevent postoperative urinary tract infection (UTI) conflicts. Oral antibiotics rely on patient adherence and can cause unwanted systemic effects. Gentamicin is a broad-spectrum antibiotic with rapid bactericidal activity and, when administered intravesically, has no systemic absorption through intact urothelium. Objective We aimed to determine whether a single intravesical instillation of gentamicin at the conclusion of urogynecologic surgery would reduce the proportion of women treated for UTI within 6 weeks postoperatively compared with sham instillation. Study Design This was a multicenter, randomized (stratified by study site, route of prolapse repair ±suburethral sling, with balanced 1:1 randomization), participant-masked, sham-controlled, study. The primary outcome was the proportion of participants treated with antibiotics for UTI within 6 weeks postoperatively. An adjusted multivariable logistic regression model was constructed to determine predictors of postoperative UTI treatment. Results Three hundred seventy participants were randomized (gentamicin, 185; sham, 185), and data from 363 participants were analyzed (gentamicin, 183; sham, 180). Nineteen women in the gentamicin group and 20 women in the sham group were treated for UTI within 6 weeks postoperatively (10.4% vs 11.1%, P = 0.87). There were no adverse events related to the instillations. Increasing age (odds ratio, 1.028 [1.000–1.057]) and number of intraoperative transurethral instrumentations (odds ratio, 1.342 [1.080–1.668]) were independent predictors of postoperative UTI treatment. Conclusions In women undergoing urogynecologic surgery, postoperative intravesical gentamicin did not reduce the incidence of postoperative UTI. The number of intraoperative transurethral instrumentations is an important, potentially modifiable risk factor for postoperative UTI treatment.

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Cystoscopy with antibiotic irrigation during pelvic reconstruction and minimally invasive gynecologic surgery: A double‐blind randomized controlled trial

Cited by 4 publications

References 29 publications

Antibiotic Solutions for Surgical Irrigation

Antibiotic Solutions for Surgical Irrigation

Antibiotic prophylaxis for surgical wound infections in clean and clean-contaminated surgery: an updated systematic review and meta-analysis

Intraoperative Gentamicin Intravesical Instillation for Prevention of Urinary Tract Infection After Urogynecologic Surgery: A Randomized Controlled Trial

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