Clinical and Economic Consequences of Wound Sepsis After Appendicectomy and Their Modification by Metronidazole or Povidone Iodine

Foster, G. E.; Bourke, J. B.; Bolwell, J.; Doran, J.; Balfour, T. W.; Holliday, Audrey R.; Hardcastle, J. D.; Marshall, Dorie

doi:10.1016/s0140-6736(81)92636-2

Cited by 44 publications

(24 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1 The significantly longer hospital stay in our study of the infected group is in agreement with previous studies. [4][5][6][7] Prophylactic use of systemic antibiotics, many of which have been used either alone or in combination, has resulted in a significant reduction in wound infection rate.…”

Section: Discussionsupporting

confidence: 93%

See 1 more Smart Citation

Topical Ampicillin for Prophylaxis Against Wound Infection in Acute Appendicitis

Alshehri

Saif

Aliyu

et al. 1994

Annals of Saudi Medicine

View full text Add to dashboard Cite

A total of 249 patients, undergoing appendectomy for acute appendicitis, were prospectively randomized into two groups. Group I, comprising 132 patients, received sterile normal saline irrigation to the surgical wound at closure. Alternatively, Group II included 117 patients, who received intraoperative topical ampicillin irrigation of the wound. Both groups were comparable with regard to age, sex, duration of symptoms, and severity of appendicitis. All patients additionally received preoperative systemic gentamicin and Flagyl. Wound infection occurred in 5.3% of Group I compared to only 0.9% of Group II (P<0.05). The reduction in infection rate was significant (P<0.05) in histologically proven appendicitis. We conclude that the addition of intraoperative topical ampicillin to systemic gentamicin and Flagyl augments prophylaxis against wound infection in acute appendicitis. Ann Saudi Med 1994;14(3):233-236. A considerable morbidity following appendectomy is caused by wound infection, 1-5 the rate of which ranges from 9% to 30% in early appendicitis and may reach up to 70% in advanced appendicitis.3-6 Systemic antibiotics were shown to reduce the wound infection rate significantly. 3,4,7 In vitro studies demonstrated 100% kill rates with clinically usable concentrations of antimicrobials in irrigating solutions after only 60-second exposure of the organisms. 8,9 Unlike parenterally administered antimicrobials, topical usage was found to attain prolonged effective local concentrations when used in the powder form. 10Experimental studies have shown that the combined use of systemic and topical antibiotics is better in advanced appendicitis than systemic antibiotics alone.11 Similarly, Seco et al. 12 have concluded in a clinical study that prophylaxis with a combination of systemic clindamycin and topical ampicillin solution, when compared with systemic clindamycin alone, was more effective in preventing wound infection after appendectomy, especially in patients with high wound contamination. However, the study of Seco et al. was criticized because the control group wounds were not irrigated with normal saline and clindamycin may not be the systemic antibiotic of choice for many surgeons. This communication aims at investigating the efficacy of the addition of topical ampicillin to systemic antimicrobials in reducing post appendectomy wound infection rate in a properly controlled randomized prospective study. Material and MethodsAll patients who underwent appendectomy through gridiron incision for clinically suspected acute appendicitis were considered for the study. Exclusion criteria were allergy to ampicillin and other systemic diseases requiring systemic antibiotic administration and therefore three patients who were allergic to ampicillin were excluded from the study, as well as another two patients who had valvular heart disease warranting preoperative prophylactic systemic ampicillin in addition to the systemic gentamicin and Flagyl. A total of 254 patients fulfilled the criteria of the study and were random...

show abstract

Section: Discussionsupporting

confidence: 93%

“…A considerable morbidity following appendectomy is caused by wound infection, [1][2][3][4][5] the rate of which ranges from 9% to 30% in early appendicitis and may reach up to 70% in advanced appendicitis. [3][4][5][6] Systemic antibiotics were shown to reduce the wound infection rate significantly.…”

mentioning

confidence: 99%

Topical Ampicillin for Prophylaxis Against Wound Infection in Acute Appendicitis

Alshehri

Saif

Aliyu

et al. 1994

Annals of Saudi Medicine

View full text Add to dashboard Cite

show abstract

“…Alguns estudos deste tipo, incluíram somente pacientes submetidos à cirurgia de apendicectomia (21)(22) . Avaliando a irrigação com PVP-I no intra-operatório dessas cirurgias, não foram encontrados resultados semelhantes aos citados anteriormente (17) .…”

Section: Discussionunclassified

“…Somente para as apendicectomias tardias, a combinação de antibiótico sistê-mico e agente antimicrobiano tópico mostrou aumento significativo na incidência de infecção da ferida cirúrgi-ca (21) , contrariamente ao esperado e aos resultados obtidos nos estudos com feridas abdominais gerais (20) . Com desenho metodológico diferente, autores (22) constataram resultados significativamente melhores para os pacientes do grupo tratado com antibiótico no que se referiu às taxas de infecção geral (p<0,01) e, especificamente, para os pacientes com apêndice perfurado ou gangrenado (p<0,05), à ausência de isolamento de bacteróides e ao menor tempo de hospitalização.…”

Section: Discussionunclassified

Uso de iodóforo tópico em feridas agudas

Oliveira

Santos

2008

Rev. esc. enferm. USP

View full text Add to dashboard Cite

RESUMENEn esta investigación se tuvo como objetivo realizar una revisión sistemática de la literatura respecto a la utilización del yodo tópico y/o compuestos en el tratamiento de las heridas agudas. Los ensayos clínicos fueron localizados por medio de la Base de Datos Cochrane, utilizándose los siguientes descriptores: iodine, acute wound, treatment, healing, infection, surgery, surgical. Veinte (52,6%), de 38 artículos, se encuadraron en los criterios de inclusión, siendo analizados en cuanto a las características de los periódicos y de los estudios y clasificados en: yodo versus otros agentes tópi-cos (4/ 20%); yodo versus apósitos (1/ 5%); yodo versus solución fisiológica (5/ 25%); yodo versus sin yodo (8/ 40%) y yodo en diferentes concentraciones (2/ 10%). Resultados favorables para el yodo se obtuvieron en el 45% de los artículos. En cuanto a las tendencias de los resultados, tres de cinco artículos se mostraron favorables para la cicatrización de heridas y prevención de infección y nueve de 15 artículos fueron desfavorables al uso del yodo tópico cuando sólo la prevención de infección fue investigada. DESCRIPTORES ABSTRACTThe purpose of this study was to carry out a systematic review of the literature regarding the use of topic iodine and/or compounds in the treatment of acute wounds. The clinical trials were searched at the Cochrane's database using the following descriptors: iodine, acute wound, treatment, healing, infection, surgery, surgical. Twenty studies (52.6%) out of 38 met the criteria for inclusion. The articles were analyzed regarding journal and study characteristics and classified into five groups: iodine versus other topic agents (4/ 20%); iodine versus types of dressings (1/ 5%); iodine versus saline solution (5/ 25%); iodine versus no iodine (8/ 40%); and iodine at different concentrations (2/ 10%). Favorable results for the use of iodine and/or compounds occurred in 45% of the studies. Three out of 5 studies showed favorable results for healing and prevention of infection and 9 out of 15 studies were not favorable when only infection prevention was investigated. KEY WORDS RESUMOEsta pesquisa objetivou realizar revisão sistemática da literatura relacionada ao uso de iodóforos tópicos no tratamento de feridas agudas. Os ensaios clínicos foram localizados por meio da Base de Dados Cochrane, utilizando-se os seguintes descritores: iodine, acute wound, treatment, healing, infection, surgery, surgical. Vinte (52,6%), dentre 38 artigos, enquadraramse nos critérios de inclusão, sendo analisados quanto às características dos periódicos e dos estudos e classificados em: iodóforo versus outros agentes tópicos (4/ 20%); iodóforo versus coberturas (1/ 5%); iodóforo versus soro fisiológico (5/ 25%); iodóforo versus sem iodóforo (8/ 40%) e iodóforos em diferentes concentrações (2/ 10%). Resultados favoráveis para os iodóforos ocorreram em 45% dos artigos. Quanto às tendências dos resultados, três dentre cinco artigos mostraram-se favoráveis para a cicatrização de feridas e prevenção de infecção e nov...

show abstract

“…Con cerning the choice of the drug, metronidazole alone, given systemically or rectally as a single shot is an effective agent to prevent wound infection [20,80,81]. Topical antiseptics or antibiotics did not show a significant bene fit [82] but combinations seem to have some value in advanced appendicitis [83]. The first-and second-genera tion cephalosporins should be administered together with metronidazole; only the third-generation cephalosporins are as effective as combinations, but they should be reserved as therapeutic antibiotic treatment for estab lished infections [31,77],…”

Section: Appendixmentioning

confidence: 99%

Standards of Antibiotic Prophylaxis in Abdominal Surgery

A¹,

Büchler²

1996

Dig Surg

View full text Add to dashboard Cite

The prophylactic use of antimicrobial agents is recommended for the prevention of numerous postoperative infections. Except for oral bowel preparations, antimicrobial prophylaxis should be limited to the operative period. Prolonged perioperative prophylaxis has not been shown to enhance effectiveness. The possibilities for toxicity, resistant superinfections and rising costs are discussed. This article provides an overview together with the standards of antimicrobial prophylaxis in abdominal surgery, principles of antibiotic administration and the choice of appropriate agents.

show abstract

Clinical and Economic Consequences of Wound Sepsis After Appendicectomy and Their Modification by Metronidazole or Povidone Iodine

Cited by 44 publications

References 7 publications

Topical Ampicillin for Prophylaxis Against Wound Infection in Acute Appendicitis

Topical Ampicillin for Prophylaxis Against Wound Infection in Acute Appendicitis

Uso de iodóforo tópico em feridas agudas

Standards of Antibiotic Prophylaxis in Abdominal Surgery

Contact Info

Product

Resources

About