The role of topical antibiotics used as prophylaxis in surgical site infection prevention

Abstract

Compared with systemic antibiotic therapy, the topical or local delivery of an antibiotic has many potential advantages. However, local antibiotics at the surgical site have received very limited approval in any of the surgical prophylaxis consensus guidelines that we are aware of. A review of the literature was carried out through searches of peer-reviewed publications in PubMed in the English language over a 30 year period between January 1980 and May 2010. Both retrospective and prospective studies were included, as well as meta-analyses. With regard to defining 'topical' or 'local' antibiotic application, the application of an antibiotic solution to the surgical site intraoperatively or immediately post-operatively was included. A number of surgical procedures have been shown to significantly benefit from perioperative topical prophylaxis, e.g. joint arthroplasty, cataract surgery and, possibly, breast augmentation. In obese patients undergoing abdominal surgery, topical surgical prophylaxis is also proven to be beneficial. The selective use of topical antibiotics as surgical prophylaxis is justified for specific procedures, such as joint arthroplasty, cataract surgery and, possibly, breast augmentation. In selective cases, such as obese patients undergoing abdominal surgery, topical surgical prophylaxis is also proven to be beneficial. Apart from these specific indications, the evidence for use of topical antibiotics in surgery is lacking in conclusive randomized controlled trials.

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

“…The size and type of sponge used for the interventions varied across studies, and 14 different brands of sponges were included; one study utilized 12 of the 14 sponge brands [15]. Three studies used only Collatamp sponges (EUSA Pharma, Oxford, UK), and other studies used a variety of different sponges [3,9,12]. A pooled assessment of Collatamp sponges was conducted because three studies utilized this brand of sponge.…”

“…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].…”

“…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 Study on the Usage Pattern of Antimicrobial Agents for the Prevention of Surgical Site Infections (SSIs) in a Tertiary Care Teaching Hospital

“…However, this was a small trial (only 70 patients in total) with a high baseline rate of SSIs in the control patients [23]. The broad-spectrum ointments provide occlusion and they may increase the epithelialization while the wound heals, but they offer only little benefit to the already epithelialized wounds [1].…”

Veiksniai, Lemiantys Operacinių Žaizdų Infekcijas Pilvo Chirurgijos Skyriuose

“…Visada būtina paimti medžiagą mikrobiologiniam ištyrimui prieš pradedant gydymą antibiotikais. Moksliniais tyrimais įrodyta, kad plataus spektro antibiotikų vartojimas yra pagrindinis rizikos veiksnys, skatinantis Acinetobacter spp, Staphylococcus aureus, atspariam meticilinui (MRSA), vankomicinui atsparių enterokokų (VRE), Clostridium difficile, grybelių išvešėjimą [8,21,22,23]. Empirinio antibiotikų skyrimo gairės rekomenduoja atsižvelgti į paciento kūno masę, o nurodyta gydymo trukmė yra tik orientacinė.…”