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

Abstract

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.

Incisional Wound Irrigation for the Prevention of Surgical Site Infection

“…Reasons for exclusion after full-text review are listed in eTable 1 in Supplement 1. We included 41 RCTs in our systematic review and 37 RCTs in the network meta-analysis, due to lack of events in all arms in 4 studies . The study characteristics of the RCTs included in the systematic review are listed in eTable 2 in Supplement 1.…”

“…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 .…”

“…Twenty-six RCTs were performed in either high- or upper-middle–income countries. Antibiotic (RR, 0.39; 95% CI, 0.18-0.83) as well as antiseptic (RR, 0.61; 95% CI, 0.41-0.92) solutions were associated with a reduction in SSIs for these countries compared with no irrigation (eFigure 1C in Supplement 1).…”

“…The sensitivity analysis after exclusion of studies with high risk of bias comprised 33 RCTs and showed a significant outcome for antibiotic (RR, 0.43; 95% CI, 0.24-0.76) and antiseptic (RR, 0.60; 95% CI, 0.43-0.82) solutions and no significant outcome for saline solution (RR, 0.80; 95% CI, 0.59-1.09) compared with no irrigation (eFigure 1E in Supplement 1).…”

“…We included 31 studies in the sensitivity analysis that explicitly mention the administration of surgical systemic antibiotic prophylaxis, which is best practice. Here, results were also comparable with the main analysis (eFigure 1F in Supplement 1).…”