Prevention of wound sepsis in gastro-intestinal surgery

Abstract

After gastro-intestinal operations wound infection is usually caused by the inoculation of bacteria present within the intestinal tract into the incision during the surgical procedure. In theory, wound sepsis may be minimized by the following methods: (a) avoiding intestinal contamination of the incision; (b) altering the normal flora of the intestinal tract by adding oral antimicrobials to bowel preparation; (c) using topical or systemic prophylactic antibiotic administration for certain high-risk patients. The relative importance of these methods of prophylaxis is described.

Wound sepsis following gastrointestinal surgery: A comparison of topical and two-dose systemic cephradine

“…Spievak (1978), in his editorial 'The prophylactic antibiotic puzzle', has pointed out that a significant reduction in the wound infection rate in most published series has only been recorded when the infection rate in the control group is in the range of 20-60 per cent, a figure that he considers unacceptably high. Inspection of the infection rates quoted by Keighley (1977) in his recent review lends support to this argument. All 18 of the published series cited in which the infection rate in the control group exceeded that reported in this series showed a significant reduction in infection rates in the antibiotic-treated groups.…”

“…A further disadvantage of topical antibiotics has been noted by Keighley (1977), namely that they are unlikely to affect the incidence of infective complications outside the wound. Our data would support this suggestion.…”

“…Although infection rates can only be reduced to acceptable levels by employing meticulous standards of surgical technique, the additional use of prophylactic antibiotics administered either topically into the wound or systemically during surgery has become increasingly popular in recent years (Keighley, 1977). However the value of such prophylactic regimens is still questioned (Spievack, 1978).…”

Review of general surgery 1977

“…Wound infection occurred in 15% of patients operated on for duodenal ulcer, 29% for gastric ulcer and an alarming 543/O for gastric carcinoma. Keighley (1977a) presents an excellent review on prevention of wound sepsis in gastro-intestinal surgery. In theory, at least, wound sepsis may be minimized by the following methods:…”

Effect of ofloxacin on oral and gastrointestinal microflora in patients undergoing gastric surgery

“…The risk of postoperative infection is considerable, and is directly related to bacterial density. Short-term prophylactic treatment with selected antimicrobial agents before gastrointestinal surgery has been shown to significantly reduce wound sepsis and other postoperative infections (1,2). The use of different types of antimicrobial prophylaxis should be evaluated (3)(4)(5).…”