Local application of gentamicin collagen implants in the prophylaxis of surgical site infections following gastrointestinal surgery: a review of clinical experience

Abstract

BackgroundSurgical site infection (SSI) is a common type of healthcare-associated infection in gastrointestinal (GI) surgical procedures, which often has major consequences for patient recovery and increased healthcare costs due to prolonged hospital stay. This article provides an overview of the efficacy and safety of prophylactic application of resorbable gentamicin-containing collagen implants (GCI) in the prevention of SSI following high-risk GI surgical procedures.MethodNine publications were identified using the PubMed online database and search terms ‘gentamicin collagen implant’ plus ‘surgical site infection’, ‘wound infection’ and ‘gastrointestinal surgery’.ResultsData from 483 patients treated prophylactically have demonstrated that GCI can reduce the wound infection rate in high-risk GI surgical procedures and improve wound healing after pilonidal sinus excision. In a study of 221 patients who underwent colorectal surgery, the wound infection rate was reduced to 5.6% in the GCI group compared to 18.4% in the control group (P < 0.01). GCI also positively influences the post-operative course for patients undergoing particularly risky procedures e.g. abdominoperineal resection (APR) combined with neoadjuvant radiotherapy. In one such patient series, GCI reduced the wound infection rate by over 70% and the length of hospital stay by 40%. Few side effects of GCI were noted in the 9 clinical studies.ConclusionsThis review demonstrates that GCI can have a positive effect on wound infection rates in high-risk GI surgery and can also improve wound healing after pilonidal sinus excision.

Gentamicin/Collagen Sponge Use May Reduce the Risk of Surgical Site Infections for Patients Undergoing Cardiac Operations: A Meta-Analysis

“…The authors who reported this latter study noted that the control group in the study received a collagen placebo sponge that may have promoted wound healing and therefore obscured the effect of the gentamicin-containing sponges. Moreover, the rate of SSI (10%) in the control group in this study was lower than that generally reported in the literature for patients undergoing loop-ileostomy closure (20%-40%) [2,[24][25][26][27]. de Bruin et al concluded that prophylactic use of gentamicin/collagen sponges can reduce rates of SSI after high-risk gastrointestinal operations and can also improve wound healing after pilonidal sinus excision [2].…”

“…de Bruin et al conducted a systematic review of published studies assessing gentamicin/collagen sponges and SSIs in various types of gastrointestinal operations [2]. They reviewed nine individual studies of medium-to-high risk operations and divided the 246 FORMANEK ET AL.…”

“…Despite the routine use of systemic prophylactic antimicrobial agents, SSIs continue to be associated with substantial morbidity following various types of surgery. Alternative methods of antimicrobial prophylaxis have therefore been studied, including the application of antimicrobial agents locally within a surgical incision [2][3][4].…”

“…A number of studies have examined the efficacy of implanting gentamicin/collagen sponges in surgical incisions to reduce the risk of SSI [2,[5][6][7][8][9][10][11][12][13][14][15][16][17]. Currently, this method of delivering antimicrobial agents is approved in 54 countries and these sponges have been used in more than two million patients; however, they are not approved for use in the United States [18].…”

Biopolymers in Medical Implants

“…Saxena et al (2009) successfully showed the generation of esophageal epithelium with survivability of esophageal epithelial cells on basement membrane matrix coated collagen scaffolds (Saxena et al 2009). Gentamicin-collagen implants are also safely and successfully used in the prophylaxis of surgical site infections after GI surgery (de Bruin et al 2010).…”