Prevention Of Surgical Wound Infections Research Articles

Comparison of Skin Antisepsis Agents

For the prevention of surgical wound infections (SSIs), local microorganism counts can be lowered by skin antisepsis prior to surgical incisions. Until now, it has been unclear which antiseptic is the most effective.This prospective randomized trial analyzed the efficacy of 2 frequently used agents in the reduction of postoperative wound complication rates after aseptic trauma surgery on the lower leg and foot. In the study, 279 consecutive participants were randomized; 112 received surgical skin preparations using chlorhexidine (CHX) (ChloraPrep; Becton Dickinson, Franklin Lakes, NJ) and 167 received preparations with povidone-iodine (PVP-I) (Braunoderm; B. Braun Melsungen AG, Melsungen, Germany). Primary clinical endpoints were SSIs and wound healing disorders (WHDs) within 6 months after surgery. Secondary outcome variables included demographic and perioperative risk factors for SSIs.Rates of WHDs and SSIs were significantly higher in the PVP-I treatment group, which experienced 9 SSIs and 12 WHDs (n = 21; 12.6%), compared to the CHX treatment group, which had 2 SSIs and 3 WHDs (n = 5; 4.5%) (P = .022). Perioperative risk factors for WHDs were obesity and longer surgery time, whereas SSIs were increased in participants with cardiovascular diseases and suction drainage. Logistic regression analysis showed that the odds of complications of wound healing were 3.5 times higher for PVP-I than for CHX (odds ratio = 3.5; 95% confidence interval, 1.1-11.2; P = .032).Preoperative skin antisepsis for trauma surgery of the lower leg and foot using CHX led to significantly fewer complications of wound healing when compared to PVP-I.

SYNTHESIS AND CHARACTERIZATION OF SILVER NANOPARTICLES AND ITS IMMOBILIZATION ON ALGINATE COATED SUTURES FOR THE PREVENTION OF SURGICAL WOUND INFECTIONS AND THE IN VITRO RELEASE STUDIES

The Silver nanoparticles are well-known for their antimicrobial, anti-inflammatory wound healing abilities. We synthesized Silver nanoparticles using chemical reduction method and the formation of the silver nanoparticles was characterized by UV-Vis absorption spectroscopy, FT-IR and SEM techniques. The minimum inhibitory concentration of the synthesized nanoparticles was determined for both gram negative and gram positive bacteria. Then these nanoparticles were coated over an absorbable surgical gut suture, after the immobilization of them in Sodium alginate, by slurry dipping technique. The controlled release of the nanoparticles checked in vitro in Simulated Body Fluid. Antimicrobial activity also evaluated by Disc diffusion method on the culture plates of E. coli and S. aureus. The successful release of silver nanoparticles under physiological PH depicts the applicability of this novel suture in surgery for the prevention of surgical wound infection and to enhance wound healing.

Antimicrobial prophylaxis for colorectal surgery

Background Research shows that administration of prophylactic antibiotics before colorectal surgery prevents postoperative surgical wound infection. The best antibiotic choice, timing of administration and route of administration remain undetermined. Objectives To establish the effectiveness of antimicrobial prophylaxis for the prevention of surgical wound infection in patients undergoing colorectal surgery. Specifically to determine: 1. whether antimicrobial prophylaxis reduces the risk of surgical wound infection; 2. the target spectrum of bacteria (aerobic or anaerobic bacteria, or both); 3. the best timing and duration of antibiotic administration; 4. the most effective route of antibiotic administration (intravenous, oral or both); 5. whether any antibiotic is clearly more effective than the currently recommended gold standard specified in published guidelines; 6. whether antibiotics should be given before or after surgery. Search methods For the original review published in 2009 we searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE (Ovid) and EMBASE (Ovid). For the update of this review we rewrote the search strategies and extended the search to cover from 1954 for MEDLINE and 1974 for EMBASE up to 7 January 2013. We searched CENTRAL on the same date (Issue 12, 2012). Selection criteria Randomised controlled trials of prophylactic antibiotic use in elective and emergency colorectal surgery, with surgical wound infection as an outcome. Data collection and analysis Data were abstracted and reviewed by one review author and checked by another only for the single, dichotomous outcome of surgical wound infection. Quality of evidence was assessed using GRADE methods. Main results This updated review includes 260 trials and 68 different antibiotics, including 24 cephalosporins and 43,451 participants. Many studies had multiple variables that separated the two study groups; these could not be compared to other studies that tested one antibiotic and had a single variable separating the two groups. We did not consider the risk of bias arising from attrition and lack of blinding of outcome assessors to affect the results for surgical wound infection. Meta-analyses demonstrated a statistically significant difference in postoperative surgical wound infection when prophylactic antibiotics were compared to placebo/no treatment (risk ratio (RR) 0.34, 95% confidence interval (CI) 0.28 to 0.41, high quality evidence). This translates to a reduction in risk from 39% to 13% with prophylactic antibiotics. The slightly higher risk of wound infection with short-term compared with long-term duration antibiotic did not reach statistical significance (RR 1.10, 95% CI 0.93 to 1.30). Similarly risk of would infection was slightly higher with single-dose antibiotics when compared with multiple dose antibiotics, but the results are compatible with benefit and harm (RR 1.30, 95% CI 0.81 to 2.10). Additional aerobic coverage and additional anaerobic coverage both showed statistically significant improvements in surgical wound infection rates (RR 0.44, 95% CI 0.29 to 0.68 and RR 0.47, 95% CI 0.31 to 0.71, respectively), as did combined oral and intravenous antibiotic prophylaxis when compared to intravenous alone (RR 0.56, 95% CI 0.43 to 0.74), or oral alone (RR 0.56, 95% CI 0.40 to 0.76). Comparison of an antibiotic with anaerobic specificity to one with aerobic specificity showed no significant advantage for either one (RR 0.84, 95% CI 0.30 to 2.36). Two small studies compared giving antibiotics before or after surgery and no significant difference in this timing was found (RR 0.67, 95% CI 0.21 to 2.15). Established gold-standard regimens recommended in major guidelines were no less effective than any other antibiotic choice. Authors' conclusions This review has found high quality evidence that antibiotics covering aerobic and anaerobic bacteria delivered orally or intravenously (or both) prior to elective colorectal surgery reduce the risk of surgical wound infection. Our review shows that antibiotics delivered within this framework can reduce the risk of postoperative surgical wound infection by as much as 75%. It is not known whether oral antibiotics would still have these effects when the colon is not empty. This aspect of antibiotic dosing has not been tested. Further research is required to establish the optimal timing and duration of dosing, and the frequency of longer-term adverse effects such as Clostridium difficile pseudomembranous colitis.

Updated Recommendations for Control of Surgical Site Infections

The objective of this study is to provide updated guidelines for the prevention of surgical wound infections based upon review and interpretation of the current and past literature. The development and treatment of surgical wound infections has always been a limiting factor to the success of surgical treatment. Although continuous improvements have been made, surgical site infections continue to occur at an unacceptable rate, annually costing billions of dollars in economic loss caused by associated morbidity and mortality. The Centers for Disease Control (CDC) provided extensive recommendations for the control of surgical infections in 1999. Review of the current literature with interpretation of the findings has been done to update the recommendations. New and sometimes conflicting studies indicate that coordination and application of techniques and procedures to decrease wound infections will be highly successful, even in patients with very high risks. This review suggests that uniform adherence to the proposed guidelines for the prevention of surgical infections could reduce wound infections significantly; namely to a target of less than 0.5% in clean wounds, less than 1% in clean contaminated wounds and less than 2% in highly contaminated wounds and decrease related costs to less than one-half of the current amount.

Supplemental Postoperative Oxygen in the Prevention of Surgical Wound Infection after Lower Limb Vascular Surgery: A Randomized Controlled Trial

Surgical wound infection (SWI) is a common complication after peripheral vascular surgery. Infections increase morbidity and costs of treatment. The aim of the present study was to test the hypothesis that supplemental postoperative oxygen decreases the incidence of SWI after lower limb revascularization. This prospective, randomized, multicenter, single-blinded trial was conducted between May 2009 and February 2010 in six secondary referral hospitals in Finland. We randomly allocated 274 patients undergoing surgery for lower limb revascularization to the study group (n=137) or a control group (n=137). The study group received supplemental inspired oxygen for the first 2 days after surgery. The main outcome was SWI. Patients were followed up for 30 days or until the SWI was healed. Logistic regression analysis was used to assess the independent effect of supplemental oxygen on the incidence of SWI. Altogether 63 (23%) patients developed SWI; 47 (75%) of the infections were superficial. There were two vascular graft infections. SWI occurred in 25 patients (18.2%) in the study group and in 38 patients (27.7%) in the control group [odds ratio (OR) 0.56, 95% confidence interval (CI) 0.30-1.04; P=0.07]. In isolated groin incisions, 3 patients of 52 (5.8%) in the study group and 12 patients of 51 (23.5%) in the control group developed SWI; OR=0.20, 95% CI 0.04-0.95; P=0.04. There was an indication that supplemental inspired oxygen tended to decrease the incidence of SWI after lower limb vascular surgery. In isolated groin incisions, the decrease of SWI incidence in the supplemental oxygen group was significant.

The Risk Factors ofClostridium difficileColitis in Colorectal Surgery

See Article on Page 329-333 Examined under colonoscopy, Clostridium difficile (C. difficile) associated colitis shows pseudomembranous colitis findings, and it is a disease that may cause severe watery diarrhea (more than 3 times per day), abdominal pain and fever. The mortality is 1-3%, and it may recur [1]. Therefore, by anticipating the development of pseudomembranous colitis, early diagnosis and following appropriate treatments, the morbidity and mortality could be lowered. Since the introduction of preoperative bowel preparation, colorectal surgery has improved greatly. The principle is to decrease perioperative bacterial infection by reducing the number of bacteria in the large intestine through the combination of mechanical bowel irrigation and oral antibiotics. Traditionally, postsurgical infection in the colorectal operation could be decreased effectively by the use of laxatives and oral administration of erythromycin and neomycin. The method so called the Nichols-Condon preparation is the administeration of cathartics and oral antibiotics, and it has been accepted widely. Presently, most anorectal surgeons (86.5%) still use this method in North America. However, since intravenous injection of antibiotics is reported to be superior to the oral administration of antibiotics, the trend is the change of the administration route. Recently, side effects and complications directly associated with the use of antibiotics have been reported. Although C. difficile colitis has been reported rarely, it has been reported up to 5.6% of patients who had complicating colorectal procedures. Particularly, in the specific subgroup associated with bowel obstruction symptoms, the incidence of C. difficile infection has been reported to be increased to 29% [2]. In geriatric patients who have received colorectal surgery, the cause of the development of C. difficile colitis is thought to be the deterioration of host immune system, nonetheless, more comprehensive mechanisms are a subject to study. The reason that oral metronidazole is favored over erythromycin in preoperative treatments is because it effectively reduces C. difficile proliferation [2]. As risk factors for C. difficile colitis developed after intestinal surgery, albumin value, prothrombin time, duration of cephalosporin and aminoglycoside injection, the duration of the use of antacid, transfusion volume, intraperitoneal abscess, fasting period, and the duration in the intensive care unit have been reported to be significant [1]. Numerous investigators consider the purpose of the use of prophylactic antibiotics prior to surgery as primarily the prevention of surgical wound infection or sepsis and other complications, and the complications such as C. difficile colitis may be considered as incidental complications. Most C. difficile colitis is cured after conservative treatments. Nonetheless, it has been reported that in severe cases, retention enema using vancomycin was attempted [3]. When planned colorectal surgeries are performed, if mechanical bowel irrigation is performed prior to surgery for the prevention of perioperative infection, intravenous injection of antibiotics once is sufficient [4]. C. difficile colitis is a complication that may develop after colorectal operation in geriatric patients, patients with suppressed immunity, and patients associated with bowel obstruction. The frequency is up to 21% [2]. Once developed, the morbidity and mortality are high, and financial loss is large, and thus best efforts should be made for its prevention and early detection. Therefore, studies to develop the standard bowel irrigation method that could achieve the purpose without causing the rapid change of the intestinal bacterial flora as well as studies on the selection of ideal antibiotics should be conducted continuously.

Single- Versus Multiple-Dose Antibiotic Prophylaxis in the Surgical Treatment of Closed Fractures: A Meta-Analysis

The use of prophylactic antibiotics in the surgical treatment of closed long bone fractures is well established. The duration and dosage of prophylaxis, however, vary significantly among surgeons. A systematic review and meta-analysis were performed to determine if multiple-dose perioperative antibiotic prophylaxis is more effective than a single preoperative dose in the prevention of surgical wound infections during the treatment of closed long bone fractures. Articles were identified by searching the following medical databases: Medline, Medline In Process & Other Non-indexed Citations, Embase, CENTRAL, and the Cochrane Database of Systematic Reviews. Relevant conference proceedings and the reference section of selected manuscripts were also searched for additional studies. Studies were included if they were prospective randomized controlled trials of patients with closed fractures treated with surgical fixation or arthroplasty. The interventions must have directly compared a single preoperative prophylactic dose to a multiple-dose perioperative strategy. Studies were excluded if they involved open fractures. The demographic information, prophylaxis strategy, wound infection rate, and risk ratio were extracted from each article. Seven trials and 3,808 patients were pooled using a random effects model. When compared to a regimen of multiple doses of prophylactic antibiotics, administration of a single preoperative dose has a risk ratio of 1.24 (95% CI 0.60-2.60). The pooled risk difference between the 2 strategies is 0.005 (95% CI -0.011-0.021). Neither result is significant. In the setting of closed long bone fractures, the pooled results failed to demonstrate superiority of multiple-dose prophylaxis over a single-dose strategy. The pooled estimates suggest that surgical wound infections are relatively rare events and that any potential difference in infection rates between prophylaxis strategies is likely quite small. However, because the confidence interval surrounding the pooled risk ratio spans 1.0 by such a large amount, we are unable to definitively recommend a preferred dosing regimen to prevent surgical wound infections. Although future research is required to ensure our prophylaxis decisions continue to be evidence based and cost-effective, it is unlikely that a single clinical trial will be able to provide the answer. The use of other quantitative methods, such as cost-effectiveness analysis, may be helpful in modeling an optimal prophylaxis strategy.

Locally Administered Antibiotics for Prophylaxis Against Surgical Wound Infection

Background: Currently, the standard for prophylaxis against surgical infection consists of perioperative systemic antibiotics. In this study, we investigated the relative efficacy of various methods of antibiotic delivery for the prevention of surgical wound infections. We hypothesized that sustained release of local antibiotics inside the wound cavity by a drug delivery system would be more effective than systemically administered antibiotics. Methods: Using a rat model, we inoculated a surgical wound in the quadriceps muscle with 8.0 × 105 colony-forming units of Staphylococcus aureus and then administered one of seven types of treatment: no treatment (control), bacitracin irrigation, calcium sulfate flakes, systemic gentamicin, local aqueous gentamicin, local gentamicin-loaded calcium sulfate flakes, and a combination of local gentamicin-loaded calcium sulfate and systemic gentamicin. The seven treatment groups consisted of ten rats each. To further evaluate a trend, the group treated with systemic gentamicin and the one treated with local gentamicin solution were extended to include twenty-five and twenty-seven rats, respectively. At forty-eight hours postoperatively, specimens from the wounds were obtained for quantitative culture. Results: The control group, the group treated with bacitracin irrigation, and the one treated with plain calcium sulfate had very high bacterial counts and high mortality rates while the groups treated with gentamicin had low bacterial counts and a 100% survival rate. Local gentamicin was significantly more effective than systemic gentamicin in reducing bacterial counts. Conclusions: The gentamicin-loaded calcium sulfate flakes did not result in bacterial counts that were significantly lower than those following systemic administration of gentamicin, which refuted our hypothesis. However, gentamicin solution injected directly into the closed wound did result in levels of bacteria that were significantly lower than those following treatment with the systemic gentamicin. Clinical Relevance: We believe that a high initial concentration of locally applied antibiotic inside the wound effectively kills bacteria present in the wound cavity, where systemic antibiotics have poor penetration, suggesting that this method of antibiotic administration may be a desirable adjunct for prophylaxis against infection in surgical wounds.

Locally Administered Antibiotics for Prophylaxis Against Surgical Wound Infection

Currently, the standard for prophylaxis against surgical infection consists of perioperative systemic antibiotics. In this study, we investigated the relative efficacy of various methods of antibiotic delivery for the prevention of surgical wound infections. We hypothesized that sustained release of local antibiotics inside the wound cavity by a drug delivery system would be more effective than systemically administered antibiotics. Using a rat model, we inoculated a surgical wound in the quadriceps muscle with 8.0 x 10(5) colony-forming units of Staphylococcus aureus and then administered one of seven types of treatment: no treatment (control), bacitracin irrigation, calcium sulfate flakes, systemic gentamicin, local aqueous gentamicin, local gentamicin-loaded calcium sulfate flakes, and a combination of local gentamicin-loaded calcium sulfate and systemic gentamicin. The seven treatment groups consisted of ten rats each. To further evaluate a trend, the group treated with systemic gentamicin and the one treated with local gentamicin solution were extended to include twenty-five and twenty-seven rats, respectively. At forty-eight hours postoperatively, specimens from the wounds were obtained for quantitative culture. The control group, the group treated with bacitracin irrigation, and the one treated with plain calcium sulfate had very high bacterial counts and high mortality rates while the groups treated with gentamicin had low bacterial counts and a 100% survival rate. Local gentamicin was significantly more effective than systemic gentamicin in reducing bacterial counts. The gentamicin-loaded calcium sulfate flakes did not result in bacterial counts that were significantly lower than those following systemic administration of gentamicin, which refuted our hypothesis. However, gentamicin solution injected directly into the closed wound did result in levels of bacteria that were significantly lower than those following treatment with the systemic gentamicin.

The Significance of the Intraoperative Repeated Dosing of Antimicrobials for Preventing Surgical Wound Infection in Colorectal Surgery

It is widely accepted that antimicrobial prophylaxis is useful for the prevention of surgical wound infection, especially in colorectal surgery. While many reports support the finding that the first dose should be administered immediately before surgery, there is less evidence concerning the ideal timing for the second dose. The purpose of this study is to examine the significance of intraoperative repeated dosing. A surgical series of 131 patients with primary colorectal cancer was retrospectively analyzed for 14 parameters, including the protocols of antimicrobial administration to determine the clinical risk factors for surgical wound infection. The overall surgical wound infection rate of the 131 patients was 16.0% (21/131). When the operation finished within 4 h after the first dose (n = 29), wound infection was observed in only one patient (3.4%). In a prolonged operation exceeding 4 h after the first dose, the surgical wound infection rates were 8.5% and 26.5%, respectively, for those with (n = 47) and without (n = 49) intraoperative repeated dosing, which were significantly different based on both a univariate analysis (P = 0.031) and a multivariate analysis (P = 0.0079). Intraoperative repeated antimicrobial dosing is therefore recommended to prevent the surgical wound infection for prolonged colorectal surgery.

Update on the Use of Antibiotics in Cutaneous Surgery

Antibiotics are often prescribed in perioperative settings, including dermatologic surgery. Given the continued evolution in the breadth and complexity of cutaneous procedures performed and inevitable localized or distant infections that occasionally occur, it seems prudent to periodically evaluate findings and recommendations from the literature regarding the use of antibiotics in cutaneous surgery. Literature review from English-language sources from the past 30 years, especially focusing on sources from the past 5 to 10 years. Data were examined for a variety of cutaneous surgical procedures, routes of antibiotic administration, and consideration of both cutaneous and distant infections. The literature suggests that, for most routine skin procedures, antibiotic use is probably not warranted for the prevention of surgical wound infection, endocarditis, and late prosthetic joint infections. During prolonged Mohs procedures, delayed repairs, grafts, takedowns of interpolation flaps, or any procedure that breaches a mucosal surface, the evidence is less clear, and decisions should be made on a case-by-case basis. Topical antibiotics are probably overused, although silver sulfadiazine may have an undeserved negative reputation among dermatologists. Systemic prophylactic antibiotics for laser resurfacing and liposuction appear not to be routinely necessary, although patients with known prior herpes infection likely should receive antiviral prophylaxis. The overall reported infection rates and infectious complications remain low in dermatologic surgery, and antibiotic therapy may be prescribed excessively or inappropriately as a result. CONCLUSION.: Antibiotics continue to be widely used, and through varying routes of administration, in the setting of dermatologic surgery. Prudent use of these agents is indicated in high-risk patients, certain anatomic locations, and the presence of overt infection. Additional studies may help clarify the most appropriate indications, and in which patient populations, in the future.

Prevention of surgical wound infection: prophylactic antibiotics in colorectal surgery

Surgical wound infection in colorectal surgery represents a significant cause of poor patient outcome. Adequate prophylaxis requires timely administration; topical gentamicin can significantly reduce infection in poorly perfused areas.

Carbon dioxide inhibits the growth rate of Staphylococcus aureus at body temperature

Since the 1930s, carbon dioxide (CO(2)) has been combined with cold storage for the preservation of food. However, its use for the prevention of surgical wound infection was long considered to be impractical. Now CO(2) is widely used during laparoscopic procedures, and a method has been developed to create a CO(2) atmosphere in an open wound. The aim of this study was to investigate the effect of CO(2) on the growth of Staphylococcus aureus at body temperature. First, S. aureus inoculated on blood agar were exposed to pure CO(2) (100%), standard anaerobic gas (5% CO(2), 10% hydrogen, 85% nitrogen), or air at 37 degrees C for a period of 24 h; then a viable count of the bacteria was made. Second, S. aureus inoculated in brain-heart infusion broth and kept at 37 degrees C were exposed to CO(2) or air for 0, 2, 4, 6, and 8 h; then the optical density of the bacteria was measured. After 24 h, the number of S. aureus on blood agar was about 100 times lower in CO(2) than in anaerobic gas (p = 0.001) and about 1,000 times lower than in air (p = 0.001). Also, in broth, there were fewer bacteria with CO(2) than with air (p < 0.01). After 2 h, the number of bacteria was increased with air (p < 0.001) but not with CO(2) (p = 0.13). After 8 h, the optical density had increased from zero to 1.2 with air but it had increased only to 0.01 with CO(2) (p = 0.001). Pure CO(2) significantly decreased the growth rate of S. aureus at body temperature. The inhibitory effect of CO(2) increased exponentially with time. Its bacteriostatic effect may help to explain the low infection rates in patients who undergo laparoscopic procedures.

Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomized controlled trials.

A systematic review was carried out to assess the relative efficacy of antimicrobial prophylaxis for the prevention of postoperative wound infection in patients undergoing colorectal surgery. MEDLINE, EMBASE, the Cochrane Trials Register and the references cited in retrieved studies were searched to identify relevant trials published between 1984 and 1995. Some 147 relevant trials were identified. The quality of trials has improved over the past 12 years. The results confirm that the use of antimicrobial prophylaxis is effective for the prevention of surgical wound infection after colorectal surgery. There was no significant difference in the rate of surgical wound infections between many different regimens. However, certain regimens appear to be inadequate (e.g. metronidazole alone, doxycycline alone, piperacillin alone, oral neomycin plus erythromycin on the day before operation). A single dose administered immediately before the operation (or short-term use) is as effective as long-term postoperative antimicrobial prophylaxis (odds ratio 1.17 (95 per cent confidence interval (c.i.) 0.90-1.53)). There is no convincing evidence to suggest that the new-generation cephalosporins are more effective than first-generation cephalosporins (odds ratio 1.07 (95 per cent c.i. 0.54-2.12)). Antibiotics selected for prophylaxis in colorectal surgery should be active against both aerobic and anaerobic bacteria. Administration should be timed to make sure that the tissue concentration of antibiotics around the wound area is sufficiently high when bacterial contamination occurs. Guidelines should be developed locally in order to achieve a more cost-effective use of antimicrobial prophylaxis in colorectal surgery.

Nonpharmacological prevention of surgical wound infections.

Postoperative wound infection is a common and serious complication of surgery. This review will focus on 2 factors known to modulate perioperative immunity: maintenance of perioperative normothermia and provision of supplemental perioperative oxygen. Hypothermia causes numerous adverse outcomes, including morbid myocardial events, increased blood loss and transfusion requirement, postsurgical wound infections, and prolonged hospitalization. Perioperative normothermia should thus be maintained unless therapeutic hypothermia is specifically indicated. Supplemental perioperative oxygen (inspired fraction of 80% instead of 30%) significantly reduces postoperative nausea and vomiting, diminishes the decrease in phagocytosis and bacterial killing usually associated with anesthesia and surgery, and reduces the rate of postoperative wound infection among patients who undergo colon resection. Available data thus suggest that supplemental perioperative oxygen improves surgical outcome with little or no associated risk.

Wirksamkeit und Verträglichkeit zweier Zephalosporine in der perioperativen Antibiotikaprophylaxe bei abdominalen und vaginalen Hysterektomien und gynäkologischen Laparotomien

Ziel der vorliegenden Untersuchung war es, die Wirksamkeit und Verträglichkeit zweier Zephalosporine in der perioperativen Antibiotikaprophylaxe bei Patientinnen, die einer abdominalen oder vaginalen Hysterektomie oder einer gynäkologischen Laparotomie unterzogen wurden, zu testen, um die Rate postoperativer Störungen der Wundheilung zu verringern. Insgesamt wurden 199 Patientinnen prospektiv in zwei Gruppen randomisiert. Die erste Gruppe (n = 100) erhielt perioperativ 1 g Cefotiam (Spizef^®) und 0,5 g Metronidazol (Clont^®) intravenös 30 min vor der Operation, während die zweite Gruppe (n = 99) 2 g Cefoxitin (Mefoxitin^®) intravenös erhielt, ebenfalls 30 min vor der Operation. Die Wirksamkeit der Prophylaxe wurde sowohl klinisch als auch aufgrund von laborchemischen Parametern objektiviert. Bei 97 Patientinnen (97%) der Cefotiam-Gruppe und bei 94 Patientinnen (94%) der Cefoxitin-Gruppe traten keine Wundheilungsstörungen auf. Keine postoperativen systemischen Infektionen wurden bei 81% der Cefotiam-Gruppe und 85% der Cefoxitin-Gruppe beobachtet. 98% der Patientinnen der Cefotiam-Gruppe und 97% der Patientinnen der Cefoxitin-Gruppe wiesen eine sehr gute bzw. gute Verträglichkeit der Medikation auf. In beiden Gruppen traten, durch die Antibiotikaprophylaxe bedingt, jeweils nur bei 3 Patientinnen Übelkeit bzw. Erbrechen auf. Die Untersuchung ergab im gesamten Kollektiv sehr niedrige Infektionsraten. Cefotiam in niedriger Dosierung und Metronidazol waren genauso wirksam wie Cefoxitin. Zephalosporine der zweiten Generation in Kombination mit Metronidazol können daher als sehr wirksame und nebenwirkungsarme Antibiotika bei der Prophylaxe lokaler Infektionen angesehen werden.

Antimicrobial prophylaxis in colorectal surgery.

volume 4,no 5,which is an update of a system-atic review of randomised controlled trials(RCTs) examining the eVectiveness of diVer-ent antimicrobial regimens used for the preven-tion of surgical wound infection in...

Kinetics and Mechanism of Release from Glyceryl Monostearate-Based Implants: Evaluation of Release in a Gel Simulating in Vivo Implantation

he overall objective of the study was to design an implantable delivery system based on glyceryl monostearate (GMS) for the site-specific delivery of antibiotics for the prevention of surgical wound infection. To design the implant, a release method had to be developed that simulate the in vivo implantation conditions to be able to predict the release characteristics from the implants when they are actually used in vivo. Also, identifying the release kinetics and mechanism and evaluating the factors that influence the release of drugs from the GMS-based matrix were necessary to allow further design of implants that could yield a desired release rate. The release of cefazolin was monitored from GMS matrixes implanted into agar gel, simulating subcutaneous tissues with respect to viscosity and water content. The gel method resulted in observation of spatial and temporal concentration profiles in the immediate vicinity of the implants, indicating the benefits of local drug delivery; however, there was no significant difference between the cumulative release profiles by the gel method or the vial release method. The release of cefazolin from the GMS-based matrix with the vial method followed Higuchi's square root of time kinetics. The release rate Q/t was found to be directly proportional to cefazolin load (A) and the surface area (SA) of the matrix as expressed by the following equation: Q/t=0.24ASA. On the basis of this equation, one can design a variety of GMS matrixes that would result in a desired release rate or release duration. This also indicated that cefazolin release followed the release kinetics of a freely soluble drug from an insoluble matrix and hence it is a diffusion-controlled process. The effect of drug solubility on the release kinetics was determined by comparing the release kinetics of the poorly water soluble ciprofloxacin (0.16 mg/mL) to that of the highly water soluble cefazolin (325 mg/mL). The release duration of ciprofloxacin (80 h) was longer than that of cefazolin (25 h) from identical GMS matrixes. Although ciprofloxacin release was initially controlled by the matrix, agitation accelerated disintegration of the matrix and release due to its poor solubility, and ciprofloxacin release appeared to be a dissolution-controlled process following zero-order release kinetics.

Economical saving due to prophylaxis in the prevention of surgical wound infection.

The objective was to know the principal risk factors that influence in the development of surgical would infection, and the economical saving achieved with the control of a single variable, that is, right prophylaxis. A prospective study was carried out at the Traumatology Department of La Paz Hospital. A total of 5260 patients operated during 1990-1993 are included. Active epidemiological surveillance was used to check patients; logistic regression was used in the multivariant analysis. The principal risk factors found were: immunodeficiency (OR = 8.67), incorrect healing (OR = 14.42), reoperated patient (patients who needed more than one surgical procedure while they are admitted; reoperations) (OR = 3.57), type of surgery (OR = 4.71) and wrong prophylaxis (OR = 6.36). Making constant all the variables except for prophylaxis, we calculated the percentage of infections prevented by a right prophylaxis, and the cost was calculated starting from the number of extra days of infection. The number of infections prevented during the four years was 310, saving a total of 194 million pesetas (1.5 million dollars), due to right prophylaxis. Cost-benefice ratio = 1/17. We consider of special importance to control this manipulable risk factor, in order to avoid the development of infections.

Prevention of surgical wound infection in craniomaxillofacial surgery with macrodose of clyndamicin plus gentamycin

Prevention of surgical wound infection in craniomaxillofacial surgery with macrodose of clyndamicin plus gentamycin