The Role of Topical Antibiotic Prophylaxis in Oculofacial Plastic Surgery

Ashraf, Davin C.; Idowu, Oluwatobi O; Wang, Qinyun; Tak, YeEun; Copperman, Thomas S; Tanaboonyawat, Sombat; Arnold, Benjamin F.; Oldenburg, Catherine E.; Vagefi, M. Reza; Kersten, Robert C.

doi:10.1016/j.ophtha.2020.07.032

Cited by 16 publications

(14 citation statements)

References 32 publications

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“…Twelve trials compared topical antibiotics to placebo, paraffin, petrolatum, and other non-antibiotic ingredients 16–26 , 28 , and one trial compared topical antibiotics to placebo and antiseptic agents 27 . Regarding type of surgery, there were five trials in dermatological surgery 16–20 , one in abdominal surgery 21 , two in orthopaedic surgery 22 , 23 , two in spinal surgery 24 , 25 , one in ocular surgery 26 , and two in cardiothoracic surgery 27 , 28 . Most trials enrolled clean (I) wounds (12 of 13) 16–20 , 22–28 , and only one trial enrolled clean-contaminated (II) wounds 21 .…”

Section: Resultsmentioning

confidence: 99%

“…Most trials enrolled clean (I) wounds (12 of 13) 16–20 , 22–28 , and only one trial enrolled clean-contaminated (II) wounds 21 . The administration of topical antibiotics included a nasal administration with mupirocin preoperatively 22 , 28 , vancomycin powder intraoperatively 24 , 25 and other topical applications postoperatively 16–21 , 23 , 26 , 27 . The use of prophylactic antibiotics before surgery in the included trials was inconsistent, and only seven used i.v.…”

Section: Resultsmentioning

confidence: 99%

“…Five trials collected data on contact dermatitis ( Fig. 3 ) 16 , 17 , 20 , 26 , 27 . The overall RR of contact dermatitis was not statistically significantly different between topical antibiotics and non-antibiotic agents (RR 2.79, 95 per cent c.i.…”

Section: Resultsmentioning

confidence: 99%

“…However, a recent review on infection prophylaxis for periorbital Mohs surgery and reconstruction contradicted the recommendation of antibiotic ointment use 34 . Although the rate of SSI in oculoplastic surgery is low, typically between 0.04 and 1.7 per cent 26 , 35 , the related complications of SSI can be devastating, possibly even vision-threatening. The included RCT of periocular surgery demonstrated that postoperative SSI was more common in the non-antibiotic group (5 versus 0 in the antibiotics group), although this did not reach statistical significance 26 .…”

Section: Discussionmentioning

confidence: 99%

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Topical antibiotic prophylaxis for surgical wound infections in clean and clean-contaminated surgery: a systematic review and meta-analysis

et al. 2021

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Background Topical antibiotics are widely prescribed as prophylaxis for surgical site infection (SSI). Despite giving high drug concentrations at local wound sites, their efficacy remains controversial. This study is a systematic review and meta-analysis designed to compare the efficacy and safety of topical antibiotics with non-antibiotic agents in preventing SSI. Methods Randomized controlled trials (RCTs) comparing topical antibiotics in patients with clean and clean-contaminated postsurgical wounds were included. Relevant trials published before 30 September 2020, were searched in the PubMed, Embase, and Cochrane databases, without language restrictions. The primary outcome was the incidence of SSIs, presented as the event rate. The secondary outcome was the incidence of contact dermatitis (safety outcome). Data were synthesized using the random-effects model, with the results expressed as risk ratio (RR) with 95 per cent confidence intervals (c.i.). Results Thirteen RCTs were included. The incidence of SSIs and contact dermatitis showed no significant difference between topical antibiotics and non-antibiotic agents (RR 0.89, 95 per cent c.i. 0.59 to 1.32 (P = 0.56, I2 = 48 per cent); and RR 2.79, 95 per cent c.i. 0.51 to 15.19 (P = 0.24, I2 = 0 per cent), respectively). In the subgroup analyses, a reduction in SSIs was also not observed in dermatological (RR 0.77, 95 per cent c.i. 0.39 to 1.55; P = 0.46, I2 = 65 per cent), ocular (RR 0.08, 95 per cent c.i. 0.00 to 1.52; P = 0.09), spinal (RR 1.34, 95 per cent c.i. 0.65 to 2.77; P = 0.43, I2 = 0 per cent), orthopaedic (RR 0.69, 95 per cent c.i. 0.37 to 1.29; P = 0.25, I2 = 0 per cent), or cardiothoracic surgeries (RR 1.60, 95 per cent c.i. 0.79 to 3.25; P = 0.19). Conclusion Given the current evidence, the routine application of topical antibiotics to surgical wounds did not reduce the incidence of SSI. Further trials are needed to assess their effectiveness in high-risk surgeries or in selected patient groups.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Topical antibiotic prophylaxis for surgical wound infections in clean and clean-contaminated surgery: a systematic review and meta-analysis

et al. 2021

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“…In this issue, Ashraf et al 3 (see page 1747) address whether topical ophthalmic antibiotics reduce surgical site infections (SSIs) after oculofacial surgery. In this unmasked randomized controlled clinical trial, patients applied either an antibiotic ointment or an ophthalmic lubricant as placebo to their wounds and were followed up for SSIs.…”

mentioning

confidence: 99%