Wound infection in emergency appendicectomy: A prospective trial with topical ampicillin and antiseptic solution irrigation

C, Tanphiphat; Sangsubhan, Chesada; Vongvaravipatr, Viroj; La-Ongthong, Banyat; Chodchoy, Viroj; Treesaranuvatana, Soontorn; Ittipong, Poonpong

doi:10.1002/bjs.1800650206

Cited by 28 publications

(15 citation statements)

References 15 publications

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“…[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. [2][3][4] Gentamicin is effective against E. coli, which was the most common aerobic organism cultured from the wound and abdomen in our study and this is in agreement with previous studies. 16,17 Unfortunately, culture for anaerobes was not carried out in our study in view of lack of facilities in the emergency setting of our hospital.…”

Section: Discussionsupporting

confidence: 92%

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

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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...

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Section: Discussionsupporting

confidence: 92%

“…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

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show abstract

“…Although most articles in the literature (both adult and pediatric) indicate that some form of antibiotic prophylaxis will diminish the incidence of wound infection after appendectomy for both acute and ruptured appendicitis [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], some authors still claim prophylaxis makes no difference [4,21,22].…”

Section: Discussionmentioning

confidence: 99%

“…The wound Penrose drain [3] or one half-inch gauze pack [4] and/or antibiotic powder [5][6][7][8][9][10][11][12] (ampicillin, 1977-1981; cefoxitin 1982-1995) were all placed in the subcutaneous space. If the infant or child was allergic to penicillin, no antibiotic powder was placed in the wound and intravenous clindamycin (or metronidazole) and gentamicin were used.…”

Section: Methodsmentioning

confidence: 99%

Wound infection prophylaxis in pediatric acute appendicitis: a 26-year prospective study

Ein

Sandler

2006

Journal of Pediatric Surgery

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“…5,[9][10][11][12] Most authors have reported rates of about 5% for wound infection and 10% for postoperative intra-abdominal abscess. 5,[9][10][11][12][14][15][16][17][18] Although some reports (both adult and pediatric, often combined) indicate that some form of antibiotic prophylaxis will diminish the incidence of both complications, 35,[37][38][39][40][41][42][43][44][45][46][47][48][49][50] others claim it makes no difference. 5,23,24,[27][28][29][30][31][32][33]36,[51][52][53][54] In our series, each ruptured appendix at operation had an obvious perforation confirmed by histopathological examination.…”

Section: Discussionmentioning

confidence: 99%

Open appendectomy for pediatric ruptured appendicitis: a historical clinical review of the prophylaxis of wound infection and postoperative intra-abdominal abscess

Ein

Nasr²,

Ein³

2013

Can J Surg

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Wound infection in emergency appendicectomy: A prospective trial with topical ampicillin and antiseptic solution irrigation

Cited by 28 publications

References 15 publications

Topical Ampicillin for Prophylaxis Against Wound Infection in Acute Appendicitis

Topical Ampicillin for Prophylaxis Against Wound Infection in Acute Appendicitis

Wound infection prophylaxis in pediatric acute appendicitis: a 26-year prospective study

Open appendectomy for pediatric ruptured appendicitis: a historical clinical review of the prophylaxis of wound infection and postoperative intra-abdominal abscess

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