Does pulsed lavage reduce the risk of surgical site infection? A systematic review and meta-analysis

Bath, Michael; Suresh, Rishi; Davies, James; Machesney, Michael

doi:10.1016/j.jhin.2021.08.021

Cited by 16 publications

(11 citation statements)

References 33 publications

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“…Pulsed lavage with 9‐L water has been reported to decrease the number of bacteria by 70% in a musculoskeletal‐infected wound model in goats, which exhibits three times more efficiency than bulb syringe irrigation 9 . Bath et al 11 reported in a systematic review and meta‐analysis that there was a significant reduction in the surgical site infection rate with the use of pulsed lavage (odds ratio: 0.39; 95% confidence interval: 0.25–0.62). Our HDPL wound therapy allowed short‐time but high‐pressure irrigation with a large amount of saline solution, which could be effective in reducing infected tissues in the present study.…”

Section: Discussionmentioning

confidence: 99%

Enhanced strategy against mediastinitis with thoracic vascular graft infection: A combination of hydro‐debridement with pulsed lavage and negative pressure wound therapies

Takagi

Wada

Igarashi

et al. 2022

Journal of Cardiac Surgery

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Background We investigated the effects of hydrodebridement with pulsed lavage (HDPL) and negative pressure (NP) wound therapies, instead of excising the prosthetic graft, in patients with postoperative thoracic vascular graft infection (TVGI). Methods Between 2020 and 2021, five TVGI patients aged 49.6 ± 19.4 years old underwent a combined therapy of HDPL and NP. The patients underwent a two‐step procedure (first step: re‐sternotomy and HDPL; second step: NP) every 3 or 4 days. After negative tissue culture, the patients underwent omentum flap wrapping and skin closure. Results No hospital death was observed. The time to skin closure was 10.8 ± 3.4 days. The time to the day in which bacteria were not cultured was 3.5 ± 2.4 days. No recurrent infections occurred for 241 ± 186 postoperative days. Conclusion Our strategy for TVGI patients may contribute to (1) sufficient infection control, (2) physical rehabilitation, and (3) less invasiveness for high‐risk patients.

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Section: Discussionmentioning

confidence: 99%

Enhanced strategy against mediastinitis with thoracic vascular graft infection: A combination of hydro‐debridement with pulsed lavage and negative pressure wound therapies

Takagi

Wada

Igarashi

et al. 2022

Journal of Cardiac Surgery

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“…The use of pulsed lavage irrigation reduces the rate of surgical site infection, especially in abdominal surgery. 19,20 We have experienced its use when performing debridement in a patient with a mycotic aneurysm of the abdominal aorta complicated with a massive gas. 21 We assumed that pulsed lavage cleaned up the infected tissue quickly and decreased the number of organisms occupying the infectious bed effectively.…”

Section: Discussionmentioning

confidence: 99%

Surgical strategy for treating mycotic aneurysms of thoracic and abdominal aorta and iliac artery: Analysis of long-term follow-up data

Fukunaga

Yoshida

Shimoji

et al. 2022

Asian Cardiovasc Thorac Ann

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Mycotic aneurysms of the aorta and iliac arteries are rare, but life-threatening conditions. We reviewed our experience to determine the best surgical strategy. Between 2007 and 2015, we operated 14 patients with mycotic aneurysms of the aortic arch ( n = 6), descending aorta ( n = 1), thoracoabdominal aorta ( n = 2), abdominal aorta ( n = 4), and iliac artery ( n = 1). The mean age was 70.4 ± 8.8 years, and 10 males were included. Blood culture, tissue culture, or both were positive in 11 patients. Four of five patients with mycotic aneurysms of the abdominal aorta and iliac artery underwent extra-anatomical bypass. Ten underwent in-situ graft replacement for managing mycotic aneurysms of the thoracic aorta. One patient with a mycotic thoracoabdominal aortic aneurysm underwent visceral bypass of the descending aorta and extra-anatomical bypass. Omental pedicle grafting was performed in 10 patients. The mean follow-up period was 8.6 ± 3.1 years. Three patients (21.4%) died. Recurrent infection was observed in one patient with a mycotic aneurysm of iliac artery three months after the initial surgery. The patient underwent extra-anatomical bypass with omental pedicle grafting as a redo. Nine patients were discharged, and no recurrence of infection was observed. Two patients died of cancer and heart failure. The five- and seven-year survival rates were 100% ± 0.0% and 85.7% ± 13.2%, respectively. A combination of radical debridement of the infectious source and omental pedicle grafting with either in-situ graft replacement or extra-anatomical bypass is an effective strategy.

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“…Takagi et al 15 proposed a combination therapy of hydrodebridement with pulsed lavage and NPWT for patients with DSWI with prosthetic graft infection. In their study, intermittent hydrodebridement with pulsed lavage consisted of a high volume of saline solution and 0.005% gentian violet and significantly reduced the number of bacteria and the surgical site infection rate 16 . Moreover, pulsed lavage with gentian violet facilitated the removal of necrotic tissues 17 .…”

Section: Commentarymentioning

confidence: 99%

“…In their study, intermittent hydrodebridement with pulsed lavage consisted of a high volume of saline solution and 0.005% gentian violet and significantly reduced the number of bacteria and the surgical site infection rate. 16 Moreover, pulsed lavage with gentian violet facilitated the removal of necrotic tissues. 17 We suspect that hydrodebridement with pulsed lavage and gentian violet enables the debridement in the entire mediastinum, including the gap between the prosthetic grafts and the narrow space dorsal to the prosthetic graft, which controls the local infection.…”

Section: Commentarymentioning

confidence: 99%

A combination of hydrodebridement with pulsed lavage and negative pressure wound therapies may enhance outcomes

Morisaki

2022

Journal of Cardiac Surgery

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Deep sternal wound infection (DSWI) with prosthetic graft infection is a rare, though lethal, complication after cardiovascular surgery via median sternotomy. This commentary is a review of a report by Takagi et al. published in the Journal of Cardiac Surgery that reported favorable outcomes in patients with DWSI with prosthetic graft infection treated with an enhanced strategy consisting of hydrodebridement with pulsed lavage and negative pressure wound therapies.

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Does pulsed lavage reduce the risk of surgical site infection? A systematic review and meta-analysis

Cited by 16 publications

References 33 publications

Enhanced strategy against mediastinitis with thoracic vascular graft infection: A combination of hydro‐debridement with pulsed lavage and negative pressure wound therapies

Enhanced strategy against mediastinitis with thoracic vascular graft infection: A combination of hydro‐debridement with pulsed lavage and negative pressure wound therapies

Surgical strategy for treating mycotic aneurysms of thoracic and abdominal aorta and iliac artery: Analysis of long-term follow-up data

A combination of hydrodebridement with pulsed lavage and negative pressure wound therapies may enhance outcomes

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