Implementation of a broader pre-operative antibiotic coverage and chlorhexidine irrigation associated with a lower postoperative surgical site infection

Abstract

<h3>Objectives:</h3> Post-operative surgical site infections (SSI) cause major health and economic burden on the patients and the healthcare systems. Multiple risk factors such as obesity and medical comorbidities are known to increase the risk of SSI in gynecologic oncology patients. Commonly used preoperative antibiotic regimens focus on targeting the skin flora as described by the enhanced recovery protocols adopted by many hospitals. We sought to investigate the effect of the addition of metronidazole to the preoperative antibiotic regimen and the intraoperative pelvic irrigation with 0.05 % chlorhexidine gluconate (CHG) on the rate of SSI after a minimally invasive surgery in gynecologic oncology. <h3>Methods:</h3> After IRB approval, we collected data from June 2018 to January 2020 for patients who underwent minimally invasive gynecologic oncology surgery at Marshall University School of Medicine. Implementation of the infection control model (pre-operative Metronidazole + intraoperative CGH pelvic irrigation) started in July 2019. Demographic and medical data, as well as intraoperative and postoperative data, were collected. The rate of SSI was analyzed before and after adoption of the model. <h3>Results:</h3> A total of 508 patients underwent a minimally invasive gynecologic oncology procedure: 262 before the implementation of the infection control model and 318 afterward. The median age of the patients was 59 years old and the rate of comorbidities was equal between the groups. The rate of SSI before the implementation of the model (Group 1) was 2.29% (6/262) and the rate of SSI afterward (Group 2- post infection control model) was 0.94% (3/318). The most common bacteria isolated from the first group were gram-negative bacilli (Klebsiella and E. Coli) and anaerobes, while Group 2 had a single patient with Klebsiella infection, one Bacteroides species infection, and one MRSA infection. All of these infected patients required pelvic abscess drainage and hospital readmission for intravenous antibiotics, with an average of 2-day hospital stay. <h3>Conclusions:</h3> The addition of metronidazole to the preoperative antibiotics regimen and the intraoperative pelvic irrigation with 0.05 % CHG appears to decrease the rate of SSI after a minimally invasive gynecologic oncology surgery. This model merits further studying in order to validate these results.