Intra-Operative Wound Irrigation with Normal Saline Solution Versus Topical Antibiotics to Avoid Wound Infection
DOI:
https://doi.org/10.51253/pafmj.v74i1.11737Keywords:
Appendectomy, Anti-bacterial agents, Wounds and Injuries, Surgical wound infection, Imipenem, CilastatinAbstract
Objective: To compare intra-operative wound irrigation with normal saline versus irrigation with Imipenem and Cilastatin
solution to develop surgical site infections in open appendectomy wounds.
Study Design: Quasi-experimental study.
Place and Duration of Study: Department of Surgery, Combined Military Hospital, Bahawalnagar Pakistan, from Oct 2015 to Oct 2017.
Methodology: Patients diagnosed with cases of acute appendicitis and planned to undergo open appendectomy were
randomly divided into two equal groups; Group-A and Group-B. Group-A was subjected to intra-operative wound irrigation
with 100 ml saline solution before skin closure. Group-B was irrigated with Imipenem and Cilastatin solution (500 mg diluted
in 10ml of distilled water). Development of post-operative Surgical Site Infection was checked till the 30th Post-Operative Day.
Results: Frequency of post-operative Surgical Side infection was comparatively less in Group-B (2.4%) as compared to GroupA (8%), which was found to be statistically significant (p-value=0.046)
Conclusion: Intra-operative wound irrigation with Imipenem and Cilastatin solution was superior to normal saline irrigation
regarding the development of Surgical Site Infection in cases undergoing open appendectomy.
Downloads
References
Khatun S, Thakur D, Shah DK. Prevalence of Retrocaecal
Appendix among Patients with Appendicitis in A Tertiary Care
Hospital of Nepal. J Nepal Med Assoc 2019 ; 57(217): 150-153.
https://doi.org/10.31729/jnma.4370.
Huckins DS, Simon HK, Copeland K, Spiro DM, Gogain J,
Wandell M. A novel biomarker panel to rule out acute
appendicitis in pediatric patients with abdominal pain. Am J
Emerg Med 2013; 31(9): 1368-1375.
https://doi.org/10.1016/j.ajem.2013.06.016.
3.Barbadoro P, Marmorale C, Recanatini C, Mazzarini G,
Pellegrini I, D'Errico MM, et al; Drainages Collaborative
Working Group. May the drain be a way in for microbes in
surgical infections? Am J Infect Control 2016; 44(3): 283-288.
https://doi.org/10.1016/j.ajic.2015.10.012.
Baracs J, Huszár O, Sajjadi SG, Horváth OP. Surgical site
infections after abdominal closure in colorectal surgery using
triclosan-coated absorbable suture (PDS Plus) vs. uncoated
sutures (PDS II): a randomized multicenter study. Surg Infect
; 12(6): 483-489. https://doi.org/10.1089/sur.2011.001.
Edmiston CE Jr, Leaper DJ. Intra-Operative Surgical Irrigation
of the Surgical Incision: What Does the Future Hold-Saline,
Antibiotic Agents, or Antiseptic Agents? Surg Infect 2016; 17(6):
-664. https://doi.org/10.1089/sur.2016.158.
Walming S, Angenete E, Block M, Bock D, Gessler B, Haglind E.
Retrospective review of risk factors for surgical wound
dehiscence and incisional hernia. BMC Surg 2017; 17(1): 19.
https://doi.org/10.1186/s12893-017-0207-0.
Heal CF, Banks JL, Lepper PD, Kontopantelis E, van Driel ML.
Topical antibiotics for preventing surgical site infection in
wounds healing by primary intention. Cochrane Database Syst
Rev 2016; 11(11): CD011426.
https://doi.org/10.1002/14651858.CD011426.pub2.
Khan M, Khalil J, Rooh-ul-Muqim, Zarin M, Touseef Ul Hassan,
Ahmed N, et al. Rate and risk factors for surgical site infection
at a tertiary care facility in Peshawar, Pakistan. J Ayub Med
Coll Abbottabad 2011; 23(1): 15-18.
Sanger PC, van Ramshorst GH, Mercan E, Huang S, Hartzler
AL, Armstrong CA, et al. A Prognostic Model of Surgical Site
Infection Using Daily Clinical Wound Assessment. J Am Coll
Surg 2016; 223(2): 259-270.e2.
https://doi.org/10.1016/j.jamcollsurg.2016.04.046.
Bucknall TE. Factors influencing wound complications: a
clinical and experimental study. Ann R Coll Surg Engl 1983;
(2): 71-77.
Pianka F, Mihaljevic AL. Vermeidung postoperativer
Infektionen : Evidenzbasierte Prinzipien [Prevention of
postoperative infections : Evidence-based principles]. Chirurg
; 88(5): 401-407. https://doi.org/10.1007/s00104-017-0384-
Andersen BR, Kallehave FL, Andersen HK. Antibiotics versus
placebo for prevention of postoperative infection after
appendicectomy. Cochrane Database Syst Rev
;(2):CD001439. Update in: Cochrane Database Syst Rev
; (3): CD001439.
https://doi.org/10.1002/14651858.CD001439.
Alfonso-Sanchez JL, Martinez IM, Martín-Moreno JM, González
RS, Botía F. Analyzing the risk factors influencing surgical site
infections: the site of environmental factors. Can J Surg 2017;
(3): 155-161. https://doi.org/10.1503/cjs.017916.
Podda M, Cillara N, Di Saverio S, Lai A, Feroci F, Luridiana G,
et al; ACOI (Italian Society of Hospital Surgeons) Study Group
on Acute Appendicitis. Antibiotics-first strategy for
uncomplicated acute appendicitis in adults is associated with
increased rates of peritonitis at surgery. A systematic review
with meta-analysis of randomized controlled trials comparing
appendectomy and non-operative management with
antibiotics. Surgeon 2017; 15(5): 303-314.
https://doi.org/10.1016/j.surge.2017.02.001.
Xiao Y, Shi G, Zhang J, Cao JG, Liu LJ, Chen TH, et al. Surgical
site infection after laparoscopic and open appendectomy: a
multicenter large consecutive cohort study. Surg Endosc 2015;
(6): 1384-1393. https://doi.org/10.1007/s00464-014-3809-y.
Tennent DJ, Shiels SM, Jennings JA, Haggard WO, Wenke JC.
Local control of polymicrobial infections via a dual antibiotic
delivery system. J Orthop Surg Res 2018; 13(1): 53.
https://doi.org/10.1186/s13018-018-0760-y.
Campbell CA. The Role of Triple-Antibiotic Saline Irrigation in
Breast Implant Surgery. Ann Plast Surg 2018; 80(6S Suppl 6):
S398-S402. https://doi.org/10.1097/SAP.0000000000001345.
Zhadan O, Becker H. Surgical Site Irrigation in Plastic Surgery.
Aesthet Surg J 2018; 38(3): 265-273.