Local Antimicrobial Administration for Prophylaxis of Surgical Site Infections

Abstract

Despite a lack of consensus guidelines, local antibiotic administration for prophylaxis of surgical site infections is used during many surgical procedures. The rationale behind this practice is to provide high antibiotic concentrations at the site of surgery while minimizing systemic exposure and adverse effects. Local antibiotic administration for surgical site prophylaxis has inherent limitations in that antibiotics are applied after the incision is made, rather than the current standard for surgical site prophylaxis that recommends providing adequate antibiotic concentrations at the site before the incision. The efficacy and safety of local application of antibiotics for surgical site prophylaxis have been assessed in different types of surgery with a variety of antibiotic agents and methods of application. We identified 22 prospective, randomized, controlled trials that evaluated local application of antibiotics for surgical site prophylaxis. These trials were subsequently divided and analyzed based on the type of surgical procedure: dermatologic, orthopedic, abdominal, colorectal, and cardiothoracic. Methods of local application analyzed included irrigations, powders, ointments, pastes, beads, sponges, and fleeces. Overall, there is a significant lack of level I evidence supporting this practice for any of the surgical genres evaluated. In addition, the literature spans several decades, and changes in surgical procedures, systemic antibiotic prophylaxis, and microbial flora make conclusions difficult to determine. Based on available data, the efficacy of local antibiotic administration for the prophylaxis of surgical site infections remains uncertain, and recommendations supporting this practice for surgical site prophylaxis cannot be made.

Topical intrawound application of vancomycin powder in addition to intravenous administration of antibiotics: A meta-analysis on the deep infection after spinal surgeries

“…However, the local ischemia, hematoma and seroma of surgical site impair the intravenous delivery of antibiotics, leading to inadequate local concentrations [9] Additionally, it has been reported that major spine infections are bacterial monomicrobial caused by Staphylococcus aureus [10]. Methicillin-resistant S. aureus (MRSA) [11].…”

Local Intra-wound Administration of Powdered Antibiotics in Orthopaedic Surgery

“…15 Topical antibiotics have also been applied locally in irrigation solutions, ointments, pastes, beads, sponges, and fleeces. 16 Local administration of powdered antibiotics is an attractive method, as it has the potential to deliver exceptionally high doses of antibiotic to the surgical site with less systemic exposure and thus potentially fewer adverse systemic effects.…”

Clinical Significance and Pathogenesis of Staphylococcal Small Colony Variants in Persistent Infections

“…By far the most frequently used antibiotic compound for local treatment is gentamicin (204,205). Various methods of local applications and studies on local antibiotic use for surgical site prophylaxis have been summarized in published reviews (206,207). Based upon available data, these reviews draw the conclusion that although some methods appear to be safe, the efficacy of local antibiotic administration (especially gentamicin) for the prophylaxis of surgical site infections remains uncertain, as subinhibitory concentrations of gentamicin induce the formation of SCVs.…”