A survey of practice and opinions on the use of topical antibiotics to prevent surgical site infection: more confusion than consensus

Cooper, Charlotte; Horner, Carolyne; Barlow, Gavin; Stryja, Jan; Sandy‐Hodgetts, Kylie; Guise, Tracey; Humphreys, Hilary

doi:10.1093/jac/dky097

Cited by 11 publications

(8 citation statements)

References 10 publications

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“…There is no consensus among the surgeons or guidelines present regarding topical antibiotics for the prevention of surgical site infection. 11 With time the instruments used in LC have evolved, techniques have improved, and even the port size and the number of ports have reduced, making laparoscopy the gold standard for cholecystectomy. Compared to open cholecystectomy, laparoscopy has the edge of small scars, less pain, quick recovery, early discharge, and early activity.…”

Section: Discussionmentioning

confidence: 99%

Topical Use of Gentamicin in Potentially Contaminated Laparoscopic Cholecystectomy After Bile Spillage During Gall Bladder Retrieval

Ali

Hussain

Jamal

et al. 2022

PAFMJ

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Objective: To observe the effects of topical Gentamycin as a prophylactic measure to control post-operative port site infection after bile spillage during gall bladder retrieval in patients undergoing laparoscopic cholecystectomy. Study Design: Quasi-experimental study. Place and Duration of Study: Pak-Emirates Military Hospital, Rawalpindi, from Feb to Aug 2019. Methodology: The study population comprised 80 patients (divided into two groups) diagnosed with cholelithiasis and underwent elective laparoscopic cholecystectomy. Seven surgeries were converted into open cholecystectomies, and bile spillage was recorded in 42 patients who underwent uneventful surgery. These patients were then examined for 30 days to evaluate port site infection. Results: It was seen that EPSI was more common in patients in the fourth decade of their life even after Gentamicin prophylaxis 6 (14.29%). A deeper analysis of the study showed that EPSI was more common in patients with Class-I obesity and their fourth decade of life. When compared to the gender, we found that the ratio of EPSI was higher in the female population (1:2) as compared to males (1:4). Conclusion: In our research, topical use of Gentamicin in potentially contaminated laparoscopic cholecystectomy after bile spillage during gall bladder retrieval proved beneficial.

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Section: Discussionmentioning

confidence: 99%

Topical Use of Gentamicin in Potentially Contaminated Laparoscopic Cholecystectomy After Bile Spillage During Gall Bladder Retrieval

Ali

Hussain

Jamal

et al. 2022

PAFMJ

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“…116 The routine usage of topical antibiotics for prevention of wound infection has been reported to contribute to the spread of antibiotic resistance. 117 In spite of this knowledge, some clinicians use antibiotics topically to prevent SSI, 118 which also contrasts with the conclusions of a Review of the Clinical Effectiveness and Guidelines: Topical Antibiotics for Infection Prevention published in 2017. 119 Here, two systematic reviews showed that in surgical patients, no statistically significant differences were observed in SSI rates with mupirocin compared with placebo, no intervention or no antibiotic;…”

Section: Surgical Techniquementioning

confidence: 95%

Surgical site infection: Prevention and management across health-care sectors

et al. 2020

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Aims, objectives and scope of document 4 Structure and content 4 2. Methodology and terminology 5 3. Epidemiology of surgical site infection 6 Surgical site infection: background 6 Signs and symptoms of SSI 7 Source of microorganisms related to SSI 10 Type of surgery and risk of SSI 10 Adjusting rates of SSI for variation in case-mix 12 Patient-related factors and the risk of SSI 12 Involving patients with diagnostics 13 Conclusion 13

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“…Indications for the use of specific types of antimicrobials, application techniques, dosages, elution properties and pharmacokinetics are poorly defined in the clinical setting leading to arbitrary variation in practice which is becoming a significant issue in orthopaedic trauma surgery [77,78].…”

Section: Local Antimicrobial Therapy and Dead Space Managementmentioning

confidence: 99%

General treatment principles for fracture-related infection: recommendations from an international expert group

Metsemakers

Morgenstern

Senneville

et al. 2019

Arch Orthop Trauma Surg

185

176

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Fracture-related infection (FRI) remains a challenging complication that creates a heavy burden for orthopaedic trauma patients, their families and treating physicians, as well as for healthcare systems. Standardization of the diagnosis of FRI has been poor, which made the undertaking and comparison of studies difficult. Recently, a consensus definition based on diagnostic criteria for FRI was published. As a well-established diagnosis is the first step in the treatment process of FRI, such a definition should not only improve the quality of published reports but also daily clinical practice. The FRI consensus group recently developed guidelines to standardize treatment pathways and outcome measures. At the center of these recommendations was the implementation of a multidisciplinary team (MDT) approach. If such a team is not available, it is recommended to refer complex cases to specialized centers where a MDT is available and physicians are experienced with the treatment of FRI. This should lead to appropriate use of antimicrobials and standardization of surgical strategies. Furthermore, an MDT could play an important role in host optimization. Overall two main surgical concepts are considered, based on the fact that fracture fixation devices primarily target fracture consolidation and can be removed after healing, in contrast to periprosthetic joint infection were the implant is permanent. The first concept consists of implant retention and the second consists of implant removal (healed fracture) or implant exchange (unhealed fracture). In both cases, deep tissue sampling for microbiological examination is mandatory. Key aspects of the surgical management of FRI are a thorough debridement, irrigation with normal saline, fracture stability, dead space management and adequate soft tissue coverage. The use of local antimicrobials needs to be strongly considered. In case of FRI, empiric broad-spectrum antibiotic therapy should be started after tissue sampling. Thereafter, this needs to be adapted according to culture results as soon as possible. Finally, a minimum follow-up of 12 months after cessation of therapy is recommended. Standardized patient outcome measures purely focusing on FRI are currently not available but the patient-reported outcomes measurement information system (PROMIS) seems to be the preferred tool to assess the patients' short and long-term outcome. This review summarizes the current general principles which should be considered during the whole treatment process of patients with FRI based on recommendations from the FRI Consensus Group. Level of evidence: Level V.

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A survey of practice and opinions on the use of topical antibiotics to prevent surgical site infection: more confusion than consensus

Abstract: There are diverse opinions and practices among healthcare professionals about the use of topical antibiotics for the prevention of SSI. This considerable, and possibly inappropriate, variation in clinical practice needs to be addressed as part of antibiotic stewardship.

Cited by 11 publications

References 10 publications

Topical Use of Gentamicin in Potentially Contaminated Laparoscopic Cholecystectomy After Bile Spillage During Gall Bladder Retrieval

Topical Use of Gentamicin in Potentially Contaminated Laparoscopic Cholecystectomy After Bile Spillage During Gall Bladder Retrieval

Surgical site infection: Prevention and management across health-care sectors

General treatment principles for fracture-related infection: recommendations from an international expert group

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