Meta-analysis of randomized and quasi-randomized clinical trials of topical antibiotics after primary closure for the prevention of surgical-site infection

Heal, Clare; Banks, Jennifer; Lepper, Phoebe D; Kontopantelis, Evangelos; Driel, Mieke van

doi:10.1002/bjs.10588

Cited by 22 publications

(12 citation statements)

References 30 publications

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“…The agents that could not be used systemically may also be used subcutaneously. There are also disadvantages such as tenderness and contact dermatitis [24].…”

Section: Discussionmentioning

confidence: 99%

Subcutaneous rifampicin versus povidone-iodine for the prevention of incisional surgical site infections following gynecologic oncology surgery — a prospective, randomized, controlled trial

Karuserci

Balat

2020

Ginekol Pol

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Objectives: Surgical site infection (SSI) following gynecologic oncology surgery is a severe problem for both patient and surgeon in terms of increasing morbidity, length of hospital stay, anxiety, and costs. In this prospective, randomized, controlled study we investigated the effect of subcutaneous rifampicin and povidone-iodine on incisional SSI following gynecologic oncology surgery. Material and methods: Three hundred patients scheduled for abdominal surgery due to any malign gynecological pathology were randomly assigned into one of three groups of 100 members each, as follows: the subcutaneous tissue was irrigated with saline in Group 1; saline + 10% povidone iodine in Group 2; saline + rifampicin in Group 3. Patients were invited to follow-up once every 10 days in a 30-day period for evaluation. Patients who developed a superficial incisional SSI were recorded. Results: No significant relationship was observed between the SSI and the subcutaneous agents used (p = 0.332). It was observed that there was a statistically significant increase in the rate of incisional surgical site infections as the period of hospitalization (p = 0.044), patient's age (p = 0.003), existence of comorbidities (p = 0.001), and perioperative blood transfusion (p = 0.021) increased. Conclusions: Subcutaneous agents are not effective in preventing surgical site infections after gynecologic oncology surgeries. Further large-scale prospective randomized controlled studies may provide other options to prevent SSIs.

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“…The agents that could not be used systemically may also be used subcutaneously. There are also disadvantages such as tenderness and contact dermatitis [24].…”

Section: Discussionmentioning

confidence: 99%

Subcutaneous rifampicin versus povidone-iodine for the prevention of incisional surgical site infections following gynecologic oncology surgery — a prospective, randomized, controlled trial

Karuserci

Balat

2020

Ginekol Pol

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“…Topical antibiotics are also applied to the surgical wound to reduce SSI. Topical antibiotics can kill bacteria that cause SSI more effectively than systemic antibiotics because the concentration of antibiotics at the wound is higher than systemic antibiotics [17]. Although there is no su cient evidence that the application of topical antibiotics is bene cial, it is said to be bene cial in abdominal surgery in obese patients [18].…”

Section: Discussionmentioning

confidence: 99%

Impact of wound irrigation during laparoscopic appendectomy on surgical site infection in acute appendicitis: a multicenter retrospective analysis

Nam¹,

Park²,

Chin-Ock³

2020

Preprint

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Background Surgical site infection (SSI) is one of the major complications after appendectomy. Among the many efforts to reduce variable risk factors, subcutaneous wound irrigation has been reported in some abdominal surgeries. However, there are no relevant literatures regarding patients who underwent laparoscopic appendectomy. This study aimed to determine the effect of wound irrigation before skin closure when performing laparoscopic appendectomy. Methods We included patients who had undergone laparoscopic appendectomy due to acute appendicitis from March 2017 to October 2019 from three hospitals. Clinical data of 333 patients were retrospectively collected, and we divided 333 patients into three groups according to the method of wound irrigation: no irrigation (n = 93), saline irrigation (n = 144), and povidone-iodine (PI) (n = 96) groups. Results A total of 15 patients (4.5%) were diagnosed with SSI within postoperative 30 days. There was no difference in the SSI rates (4.3% vs. 5.1% vs. 4.5%, p = 0.953). None of the factors were associated with SSI among the variables (sex, age, ASA, perforated appendicitis, preoperative WBC and hemoglobin levels, operation time, wound irrigation, type of wound closure material, and preoperative and postoperative fever). Conclusions Wound irrigation did not affect the SSI rate in patients who underwent laparoscopic appendectomy.

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“…Another strength was comparison of individual topical antibiotics to placebo or antiseptic, which was not done in similar studies. 6 , 8 …”

Section: Discussionmentioning

confidence: 99%

“… 7 On the other hand, through their systematic review and meta-analysis, Heal et al concluded topical antibiotics probably prevent SSIs compared to no antibiotic or with antiseptic. 8 …”

Section: Introductionmentioning

confidence: 99%

A systematic review and meta-analysis on the use of prophylactic topical antibiotics for the prevention of uncomplicated wound infections

Tong

Hammer

Johnson

et al. 2018

IDR

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BackgroundThe prescription of topical antibiotics for the prevention of infections in uncomplicated wounds is common. However, the efficacy is not well reported. Therefore, the objective of the study was to conduct a systematic review and meta-analysis of the available evidence on prevention of uncomplicated wound infections by prophylactic topical antibiotics.Materials and methodsThe search included Pubmed, Google Scholar, SCOPUS, Embase, Cochrane, ClinicalTrials.gov, International Clinical Trials Registry Platform, National Technical Information Service, and the National Guidelines Clearinghouse.ResultsWe identified eight randomized controlled trials and four quasi-randomized trials that met the criteria for the systematic review. Of these trials, 11 studies were pooled for meta-analysis to compare the effects of topical antibiotics versus placebo and 4 studies were pooled for comparison of effects of topical antibiotics versus topical antiseptics on uncomplicated wounds. Fewer wound infections occurred in the topical antibiotic arms compared to placebo (pooled risk ratio: 0.57 [95% CI: 0.37 to 0.86]; p=0.01 and pooled risk difference: −3.1% [95% CI: −5.8% to −0.34%]; p=0.03). Compared to antiseptics, topical antibiotics demonstrated statistically significant relative risk reduction (pooled risk ratio: 0.56 [95% CI: 0.23 to 0.91]; p=0.02), while there was no significant absolute risk reduction (pooled risk difference: −3.7% [95% CI: −7.9% to +0.6%]; p=0.09).ConclusionTopical antibiotics are effective in reducing wound infections after surgical procedures, but the absolute benefit is small. Given the global emergence of antimicrobial resistance, judicious use of antibiotics is encouraged and use of antiseptics should be considered as a reasonable alternative to topical antibiotics.

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Meta-analysis of randomized and quasi-randomized clinical trials of topical antibiotics after primary closure for the prevention of surgical-site infection

Abstract: Topical antibiotics probably prevent SSI compared with no topical antibiotic or antiseptic. No conclusion can be drawn regarding whether they cause allergic contact dermatitis.

Cited by 22 publications

References 30 publications

Subcutaneous rifampicin versus povidone-iodine for the prevention of incisional surgical site infections following gynecologic oncology surgery — a prospective, randomized, controlled trial

Subcutaneous rifampicin versus povidone-iodine for the prevention of incisional surgical site infections following gynecologic oncology surgery — a prospective, randomized, controlled trial

Impact of wound irrigation during laparoscopic appendectomy on surgical site infection in acute appendicitis: a multicenter retrospective analysis

A systematic review and meta-analysis on the use of prophylactic topical antibiotics for the prevention of uncomplicated wound infections

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