Prevention of Surgical Site Infection Following Open Spine Surgery: The Efficacy of Intraoperative Wound Irrigation with Normal Saline Containing Gentamicin Versus Dilute Povidone-Iodine

Inojie, Moses Osaodion; Okwunodulu, Okwuoma; Ndubuisi, Chika Anele; Campbell, Francis Chukwuebuka; Ohaegbulam, Samuel Chwukwunoyerem

doi:10.1016/j.wneu.2022.12.134

Cited by 7 publications

(14 citation statements)

References 31 publications

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“…The antibiotics applied in a solution in the different studies were cefazolin, gentamicin, rifampicin, imipenem, clindamycin, ceftriaxone, metronidazole, and bacitracin . All but 2 studies described the antibiotic solutions to be aqueous.…”

Section: Resultsmentioning

confidence: 99%

“…All but 2 studies described the antibiotic solutions to be aqueous. All antiseptic solutions studied were aqueous, with 18 RCTs investigating iodine solutions ranging from 0.1% to 10% in concentration. Other antiseptics used were polyhexanide, chlorhexidine, hydrogen peroxide, and electrolyzed strongly acidic aqueous solution .…”

Section: Resultsmentioning

confidence: 99%

“…We carried out a subgroup analysis on the 15 studies that investigated clean surgery (eFigure 1A in Supplement 1). Eleven of these 15 RCTs reported at least 1 SSI and were, therefore, included in the network meta-analysis. The only significant benefit was found for antiseptic solutions compared with saline solutions, as seen in the league table (RR, 0.21; 95% CI, 0.08-0.51).…”

Section: Resultsmentioning

confidence: 99%

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Incisional Wound Irrigation for the Prevention of Surgical Site Infection

Groenen,

Bontekoning,

Jalalzadeh

et al. 2024

JAMA Surg

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ImportanceSurgical site infections (SSIs) are common postoperative complications and associated with significant morbidity, mortality, and costs. Prophylactic intraoperative incisional wound irrigation is used to reduce the risk of SSIs, and there is great variation in the type of irrigation solutions and their use.ObjectiveTo compare the outcomes of different types of incisional prophylactic intraoperative incisional wound irrigation for the prevention of SSIs in all types of surgery.Data SourcesPubMed, Embase, CENTRAL, and CINAHL databases were searched up to June 12, 2023.Study SelectionIncluded in this study were randomized clinical trials (RCTs) comparing incisional prophylactic intraoperative incisional wound irrigation with no irrigation or comparing irrigation using different types of solutions, with SSI as a reported outcome. Studies investigating intracavity lavage were excluded.Data Extraction and SynthesisThis systematic review and network meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Two reviewers independently extracted the data and assessed the risk of bias within individual RCTs using the Cochrane Risk of Bias 2 tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A frequentist network meta-analysis was conducted, and relative risks (RRs) with corresponding 95% CIs were reported.Main Outcome and MeasureThe primary study outcome was SSI.ResultsA total of 1587 articles were identified, of which 41 RCTs were included in the systematic review, with 17 188 patients reporting 1328 SSIs, resulting in an overall incidence of 7.7%. Compared with no irrigation, antiseptic solutions (RR, 0.60; 95% CI, 0.44-0.81; high level of certainty) and antibiotic solutions (RR, 0.46; 95% CI, 0.29-0.73; low level of certainty) were associated with a beneficial reduction in SSIs. Saline irrigation showed no statistically significant difference compared with no irrigation (RR, 0.83; 95% CI, 0.63-1.09; moderate level of certainty).Conclusions and RelevanceThis systematic review and network meta-analysis found high-certainty evidence that prophylactic intraoperative incisional wound irrigation with antiseptic solutions was associated with a reduction in SSIs. It is suggested that the use of antibiotic wound irrigation be avoided due to the inferior certainty of evidence for its outcome and global antimicrobial resistance concerns.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Incisional Wound Irrigation for the Prevention of Surgical Site Infection

Groenen,

Bontekoning,

Jalalzadeh

et al. 2024

JAMA Surg

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“…Less than one third of studies (32%) were considered to be large studies with over 500 participants, with the majority of studies conducted in high-income [21] countries (74%) and on orthopaedic procedures (25%). All seven studies from lower [22–26] and upper middle-income countries [27,28] were smaller studies with less than 500 participants.…”

Section: Latest Research For Surgical Antimicrobial Prophylaxismentioning

confidence: 99%

“…Two spinal surgery studies were included in our review and assessed the contentious issue of intra wound applications of topical gentamicin [24] and vancomycin [25]. Both studies were in favour of the comparator standard of care arms but had small sample sizes (<500 patients) and conducted at single sites, making them less generalizable to inform practice recommendations.…”

Section: Orthopaedic Surgerymentioning

confidence: 99%

Surgical site infection prophylaxis: what have we learned and are we making progress?

Ierano,

Hall,

James

2023

Current Opinion in Infectious Diseases

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Purpose of review This review aims to discuss the current state of surgical antimicrobial prophylaxis (SAP) evidence for surgical site infection prevention. Despite decades of research, knowledge gaps persist in identifying optimal SAP regimens. Recent findings Recent randomised controlled trials highlight ongoing heterogeneity in study design. Key new findings support the use of oral preoperative SAP for colorectal surgery and advise against the use of SAP for transperineal prostate biopsy. There is growing evidence for culture-based SAP over empiric use for transrectal prostate biopsy. Contentious issues remain regarding topical antimicrobials for cardiac procedures involving sternotomy, the necessity of SAP for wire lumpectomy and laparoscopic cholecystectomy for both mild or moderate acute cholecystitis. Procedures where SAP is not indicated, yet research is still being conducted on this topic include dental implants and clean orthopaedic procedures. Summary Research efforts continue with numerous trials published and registered to determine optimal SAP regimens. However, many efforts are suboptimal due to poor statistical design and redundant questions already answered by existing literature. To improve practice and influence surgeons prescribing behaviour future RCTs should be well powered, with large sample sizes across multiple sites, focusing on clinically relevant questions.

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