General Assembly, Prevention, Antiseptic Irrigation Solution: Proceedings of International Consensus on Orthopedic Infections

Intraoperative bacitracin irrigations for the prevention of surgical site infections—Consider the alternatives

“…5,6,9 Use of dilute povidone-iodine solution prior to wound closure is supported by the World Health Organization and Centers for Disease Control and Prevention (CDC) guidelines on the prevention of SSIs and International Consensus Meeting on Orthopedic Infections. 6,9,10 Further study and high-quality evidence are needed on the role of topical antimicrobials in this setting. Limited high-quality data are available regarding the use of antimicrobial irrigations, pastes, and washes that are administered topically.…”

“…4,5 Multiple guidelines on SSI prevention as well as the International Consensus Meeting on Orthopedic Infections statement either do not recommend the use of antibiotic irrigations or, due to insufficient evidence, make no recommendation (Table 1). 6 Published literature on antibiotic irrigations for the prevention of SSIs mostly consists of retrospective, observational, single-center studies across a variety of surgery types including orthopedic, neurosurgical, cardiac, abdominal, vascular, and breast reconstruction procedures. 4,6,11 Reviews and meta-analyses conducted in the last 60 years have repeatedly concluded that available studies have been flawed and of low quality, and that they are insufficient to support intraoperative topical antibiotics for SSI prevention.…”

“…6 Published literature on antibiotic irrigations for the prevention of SSIs mostly consists of retrospective, observational, single-center studies across a variety of surgery types including orthopedic, neurosurgical, cardiac, abdominal, vascular, and breast reconstruction procedures. 4,6,11 Reviews and meta-analyses conducted in the last 60 years have repeatedly concluded that available studies have been flawed and of low quality, and that they are insufficient to support intraoperative topical antibiotics for SSI prevention. 4 One recent meta-analysis of 21 randomized-controlled trials (RCTs) found no benefit of antibiotic irrigations compared to saline or no irrigation (OR, 1.16; 95% CI, 0.64-2.12; P = .63), but it found a decrease in SSIs with the use of intraoperative aqueous povidone-iodine solution compared to saline irrigation (OR, 0.31; 95% CI, 0.13-0.73; P = .007).…”

Intraoperative and Postoperative Infection Prevention

“…Furthermore, experts at the second ICM on Musculoskeletal Infection voted with a "super majority, strong consensus" in favor of "dilute povidone-iodine use for the irrigation of wounds during surgical procedures" [76]. Evidence in the form of a meta-analysis of 7 randomized controlled trials pertaining to abdominal surgery and spinal surgery [77e83] demonstrates that irrigation with aqueous povidone-iodine confers benefit vs plain saline irrigation (odds ratio, 0.31; P ¼ .007), with an effect equivalent to 50 fewer SSIs per 1000 procedures [84].…”

“…A meta-analysis of these studies also demonstrated no significant difference between antibiotic irrigation, no irrigation, and saline irrigation (odds ratio, 1.16; P ¼ .63) [84]. Further concerns have been raised regarding antimicrobial resistance, cost, and hypersensitivity with the use of antibiotics in irrigation solution [76,91,92].…”