Topical antimicrobial prophylaxis in colorectal surgery for the prevention of surgical wound infection: a systematic review and meta-analysis

Nelson, Richard L.; Iqbal, Nusrat; Kravets, Anatoliy; Khateeb, Rafina; Raza, Muhammad; Siddiqui, Muhammed R; Taha, Isra; Tummala, Apoorva; Epple, R.; Huang, Song; Wen, Ming

doi:10.1007/s10151-018-1814-1

Cited by 15 publications

(14 citation statements)

References 53 publications

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“…Similarly, an RCT [ 18 ] that included 291 patients who underwent laparoscopic colorectal surgery at a single center also failed to prove the efficacy of the gentamicin-collagen sponge. However, in a recent meta-analysis [ 5 ], a sensitivity analysis of abdominal wounds revealed that a gentamicin-collagen sponge could reduce SSI in colorectal surgery (RR, 0.38; 95% CI, 0.20–0.72).…”

Section: Discussionmentioning

confidence: 99%

“…However, in the colorectal surgery field, a large-scale randomized control study [ 4 ] of gentamicin-containing sponges failed to prove their effectiveness. Nevertheless, a recent meta-analysis that excluded this study due to high risk of bias reported that, based on sensitivity analyses of abdominal wounds, gentamicin-collagen sponges could reduce the risk of SSI (relative risk [RR], 0.38; 95% CI, 0.20–0.72) [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Use of gentamicin-collagen sponge (Collatamp® G) in minimally invasive colorectal cancer surgery: A propensity score-matched study

Lee

Park

et al. 2022

PLoS ONE

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Background Minimally invasive surgery is commonly used to treat patients with colorectal cancer, although it can cause surgical site infections (SSIs) that can affect the oncologic outcome. Use of a gentamicin-collagen sponge may help reduce the occurrence of SSIs. We aimed to determine the effectiveness of a gentamicin-collagen sponge in reducing SSIs in minimally invasive surgery for colorectal cancer. Methods We retrospectively reviewed the records of 310 patients who were diagnosed with colorectal cancer at our hospital and underwent minimally invasive surgery between December 1, 2018, and February 28, 2021. Propensity score matching was conducted with a 1:1 ratio using logistic regression. The primary outcome was the incidence of SSIs in the mini-laparotomy wound. The secondary endpoints were factors affecting the incidence of SSIs. Results After propensity score matching, 130 patients were assigned to each group. There were no differences in clinical characteristics between the two groups. SSIs occurred in 2 (1.5%) and 3 (2.3%) patients in the gentamicin-collagen sponge and control groups, respectively (p<0.999). The following factors showed a statistically significant association with SSIs: body mass index >25 kg/m2 (odds ratio, 39.0; 95% confidence interval, 1.90–802.21; p = 0.018), liver disease (odds ratio, 254.8; 95% confidence interval, 10.43–6222.61; p = 0.001), and right hemicolectomy (odds ratio, 36.22; 95% confidence interval, 2.37–554.63; p = 0.010). Conclusion Applying a gentamicin-collagen sponge to the mini-laparotomy wound did not reduce the frequency of SSIs. Further studies should be conducted on whether the selective use of gentamicin-collagen sponges may help reduce SSIs in high-risk patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Use of gentamicin-collagen sponge (Collatamp® G) in minimally invasive colorectal cancer surgery: A propensity score-matched study

Lee

Park

et al. 2022

PLoS ONE

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“…Both the current WHO SSI prevention guidelines and subsequently updated meta-analyses could not resolve methodological and generalisability issues of the underlying trials. 23 The included trials were mostly at high risk of bias, contained narrow groups of patients, and did not include any patients undergoing contaminated surgery. 9 FALCON addresses these issues, by being at low risk of bias, being larger than all the combined randomised trial data for clean-contaminated and contaminated or dirty surgery to date, and being the only multicountry randomised trial done exclusively in LMICs, where the burden of SSI is highest.…”

Section: Discussionmentioning

confidence: 99%

Reducing surgical site infections in low-income and middle-income countries (FALCON): a pragmatic, multicentre, stratified, randomised controlled trial

Runigamugabo¹,

Sodonougbo²,

Behanzin³

et al. 2021

The Lancet

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Background Surgical site infection (SSI) is the most common postoperative complication worldwide. WHO guidelines to prevent SSI recommend alcoholic chlorhexidine skin preparation and fascial closure using triclosan-coated sutures, but called for assessment of both interventions in low-resource settings. This study aimed to test both interventions in low-income and middle-income countries.Methods FALCON was a 2 × 2 factorial, randomised controlled trial stratified by whether surgery was cleancontaminated, or contaminated or dirty, including patients undergoing abdominal surgery with a skin incision of 5 cm or greater. This trial was undertaken in 54 hospitals in seven countries (

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“…The evidence for prophylactic application of local antibiotics to wounds (of any kind) in other surgical specialties is conflicting, with variability in their efficacy between specialties and procedure types. 43,44 Currently, their routine use in vascular groin wounds cannot be recommended.…”

Section: Discussionmentioning

confidence: 99%

Editor's Choice – Systematic Review and Meta-Analysis of Wound Adjuncts for the Prevention of Groin Wound Surgical Site Infection in Arterial Surgery

Gwilym

Dovell

Dattani

et al. 2021

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSThis review supports closed incision negative pressure wound therapy (ciNPWT) as an effective intervention for preventing both superficial and deep surgical site infections (SSIs) in groin incisions following arterial intervention. Available evidence suggests local antibiotics do not reduce overall SSI rates, but may reduce superficial SSIs, however data are heterogenous and lacking. Subcuticular sutures, as opposed to other methods of closure, appear to reduce SSIs. The cost effectiveness of ciNPWT, and efficacy of local antibiotics (for both superficial and deep SSI) in vascular groin wounds, are research questions that should be addressed with future randomised trials.Objective: Groin incision surgical site infections (SSIs) following arterial surgery are common and are a source of considerable morbidity. This review evaluates interventions and adjuncts delivered immediately before, during, or after skin closure, to prevent SSIs in patients undergoing arterial interventions involving a groin incision.Data sources: MEDLINE, EMBASE, and CENTRAL databases were searched. Review methods: This review was undertaken according to established international reporting guidelines and was registered prospectively with the International prospective register of systematic reviews (CRD42020185170). The MEDLINE, EMBASE, and CENTRAL databases were searched using pre-defined search terms without date restriction. Randomised controlled trials (RCTs) and observational studies recruiting patients with non-infected groin incisions for arterial exposure were included; SSI rates and other outcomes were captured. Interventions reported in two or more studies were subjected to meta-analysis. Results:The search identified 1 532 articles. Seventeen RCTs and seven observational studies, reporting on 3 747 patients undergoing 4 130 groin incisions were included. A total of seven interventions and nine outcomes were reported upon. Prophylactic closed incision negative pressure wound therapy (ciNPWT) reduced groin SSIs compared with standard dressings (odds ratio [OR] 0.34, 95% CI 0.23 e 0.51; p < .001, GRADE strength of evidence: moderate). Local antibiotics did not reduce groin SSIs (OR 0.60 95% CI 0.30 e 1.21 p ¼ .15, GRADE strength: low). Subcuticular sutures (vs. transdermal sutures or clips) reduced groin SSI rates (OR 0.33, 95% CI 0.17 e 0.65, p ¼ .001, GRADE strength: low). Wound drains, platelet rich plasma, fibrin glue, and silver alginate dressings did not show any significant effect on SSI rates. Conclusion:There is evidence that ciNPWT and subcuticular sutures reduce groin SSI in patients undergoing arterial vascular interventions involving a groin incision. Local antibiotics did not reduce groin wound SSI, although the strength of this evidence is lower. No other interventions demonstrated a significant effect.

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Topical antimicrobial prophylaxis in colorectal surgery for the prevention of surgical wound infection: a systematic review and meta-analysis

Cited by 15 publications

References 53 publications

Use of gentamicin-collagen sponge (Collatamp® G) in minimally invasive colorectal cancer surgery: A propensity score-matched study

Use of gentamicin-collagen sponge (Collatamp® G) in minimally invasive colorectal cancer surgery: A propensity score-matched study

Reducing surgical site infections in low-income and middle-income countries (FALCON): a pragmatic, multicentre, stratified, randomised controlled trial

Editor's Choice – Systematic Review and Meta-Analysis of Wound Adjuncts for the Prevention of Groin Wound Surgical Site Infection in Arterial Surgery

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