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Wang X, Fu L, Guo S, Fang X. A meta-analysis examined the effect of topical nursing application of antimicrobial as a prophylaxis for the stoppage of surgical wound infection in colorectal surgery. Int Wound J 2023. [PMID: 36727574 DOI: 10.1111/iwj.14064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 02/03/2023] Open
Abstract
To assess the impact of topical antimicrobial (TA) as a prophylaxis for the stoppage of surgical wound infection (SWI) in colorectal surgery (CS), we lead a meta-analysis. 9160 participants with CS were enrolled in the chosen studies; 4719 of them used TA, while 4441 served as controls. To assess the effectiveness of TA application in lowering SWIs following CS, odds ratios (OR) with 95% confidence intervals (CIs) were computed with a dichotomous technique with a fixed- or random-effect model. Significantly lower SWIs post CS for TA as whole (OR, 0.50; 95% CI, 0.38-0.64; P < .001), gentamicin collagen sponge and beads (OR, 0.52; 95% CI, 0.32-0.86; P = .01), triclosan impregnated fascial suture (OR, 0.57; 95% CI, 0.38-0.84; P = .005), antibiotic powder, ointment, lavage, or injection for the abdominal wound (OR, 0.35; 95% CI, 0.21-0.59; P < .001), and ionised silver dressing on the closed abdominal wound (OR, 0.45; 95% CI, 0.27-0.77; P = .003) compared to control. Significantly lower SWIs post CS for TA as a whole, gentamicin collagen sponge and beads, triclosan impregnated fascial sutures, antibiotic powder, ointment, lavage, or injection for the abdominal wound, and ionised silver dressing on the closed abdominal wound compared with control. The low sample size of 8 out of the 39 included studies in this meta-analysis calls for precaution when analysing the outcomes.
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Affiliation(s)
- Xue Wang
- School of Nursing, Jilin University, Jilin, P.R. China
| | - Liming Fu
- Department of Traditional Chinese Medicine, Bethune First Hospital of Jilin University, Changchun, P.R. China
| | - Shaoning Guo
- Department of Nursing, Bethune First Hospital Of Jilin University, Changchun, P.R. China
| | - Xuedong Fang
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Jilin, P.R. China
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Lee KY, Lee J, Park YY, Oh ST. Use of gentamicin-collagen sponge (Collatamp® G) in minimally invasive colorectal cancer surgery: A propensity score-matched study. PLoS One 2022; 17:e0264513. [PMID: 35344540 PMCID: PMC8959166 DOI: 10.1371/journal.pone.0264513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 02/14/2022] [Indexed: 11/18/2022] Open
Abstract
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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Affiliation(s)
- Kil-yong Lee
- Division of Coloproctology, Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, South Korea
| | - Jaeim Lee
- Division of Coloproctology, Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, South Korea
- * E-mail:
| | - Youn Young Park
- Division of Coloproctology, Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, South Korea
| | - Seong Taek Oh
- Division of Coloproctology, Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, South Korea
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Li Y, Zhou J. A Preliminary Exploration of the Efficacy of Gentamicin Sponges in the Prevention and Treatment of Wound Infections. Infect Drug Resist 2021; 14:2633-2644. [PMID: 34267529 PMCID: PMC8275191 DOI: 10.2147/idr.s315105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/03/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose This study aimed to construct drug-loading and drug-releasing quantitative equations for gentamicin sponges in addition to realizing a gentamicin sponge for wound infection prevention and treatment. Methods Sterile sponges were cut into pieces of 1×1 × 0.5 cm and immersed in 40, 16, 8, 4, 1.6, 0.8, or 0 mg/mL of gentamicin solution for 12, 24, 48, 96, or 120 h to evaluate their gentamicin loading. The sponges were subsequently immersed in the gentamicin solution of different concentrations for 48 h, air-dried, and then immersed in 10 mL of 0.9% physiological saline to evaluate the gentamicin release. Methicillin-sensitive Staphylococcus aureus (MSSA) and Pseudomonas aeruginosa were used to explore the sponges’ infection prevention scheme. In addition, a rat femur fracture with wound infection model was used to assess the infection treatment scheme. Results The antibacterial zone sizes of the sponges immersed in 40, 16, 8, 4, 1.6, and 0.8 mg/mL of the gentamicin solution were larger than those of the 0 mg/mL air-dried sponge, and the difference was statistically significant (p < 0.01, p < 0.01, p < 0.01, p < 0.01, p < 0.01, and p < 0.01, respectively). The rats in the 40, 16, and 8 mg/mL air-dried sponge groups had no wound suppuration in either the MSSA or P. aeruginosa rat infection models. Conclusion A quantified equation for the sponges’ gentamicin loading and release was achieved with high accuracy. Furthermore, we recommend the 40, 16, or 8 mg/mL air-dried sponge for the treatment of wounds with antibiotic-sensitive bacterial infections.
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Affiliation(s)
- Yongduo Li
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Junlin Zhou
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
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Temperature-responsive PNDJ hydrogels provide high and sustained antimicrobial concentrations in surgical sites. Drug Deliv Transl Res 2020; 9:802-815. [PMID: 30891707 DOI: 10.1007/s13346-019-00630-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Local antimicrobial delivery is a promising strategy for improving treatment of deep surgical site infections (SSIs) by eradicating bacteria that remain in the wound or around its margins after surgical debridement. Eradication of biofilm bacteria can require sustained exposure to high antimicrobial concentrations (we estimate 100-1000 μg/mL sustained for 24 h) which are far in excess of what can be provided by systemic administration. We have previously reported the development of temperature-responsive hydrogels based on poly(N-isopropylacrylamide-co-dimethylbutyrolactone acrylate-co-Jeffamine M-1000 acrylamide) (PNDJ) that provide sustained antimicrobial release in vitro and are effective in treating a rabbit model of osteomyelitis when instilled after surgical debridement. In this work, we sought to measure in vivo antimicrobial release from PNDJ hydrogels and the antimicrobial concentrations provided in adjacent tissues. PNDJ hydrogels containing tobramycin and vancomycin were administered in four dosing sites in rabbits (intramedullary in the femoral canal, soft tissue defect in the quadriceps, intramuscular injection in the hamstrings, and intra-articular injection in the knee). Gel and tissue were collected up to 72 h after dosing and drug levels were analyzed. In vivo antimicrobial release (43-95% after 72 h) was markedly faster than in vitro release. Drug levels varied significantly depending on the dosing site but not between polymer formulations tested. Notably, total antimicrobial concentrations in adjacent tissue in all dosing sites were sustained at estimated biofilm-eradicating levels for at least 24 h (461-3161 μg/mL at 24 h). These results suggest that antimicrobial-loaded PNDJ hydrogels are promising for improving the treatment of biofilm-based SSIs.
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Serum C-reactive protein level after ventral hernia repair with mesh reinforcement can predict infectious complications: a retrospective cohort study. Hernia 2018; 24:41-48. [DOI: 10.1007/s10029-018-1844-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/29/2018] [Indexed: 12/14/2022]
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Pochhammer J, Köhler J, Schäffer M. Colorectal Surgical Site Infections and Their Causative Pathogens: Differences between Left- and Right-Side Resections. Surg Infect (Larchmt) 2018; 20:62-70. [PMID: 30358512 DOI: 10.1089/sur.2018.143] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Surgical site infections (SSIs), after colorectal resection, pose a significant burden. Recognition of the spectrum of potentially involved pathogens is crucial for determining correct antibiotic prophylaxis. This study aimed to determine whether the distribution of SSI-associated pathogens depends on the location of the colorectal resection. METHODS We retrospectively categorized 2713 consecutive colon resections as left- or right-side operations, identified patients having concurrent peritonitis or development of postoperative SSIs and peritonitis, and assigned all subcutaneously and intra-abdominally isolated pathogens according to the location of the resection. RESULTS Gram-positive cocci (especially enterococci) and gram-negative bacilli (especially Pseudomonas aeruginosa) were isolated more frequently from patients in whom SSIs developed after left-side resections than after right-side resections (52.5% vs. 32.6%, p < 0.01 and 15.9% vs. 6.7%, p < 0.01, respectively); enterococci were the causative organisms in a large percentage of SSIs (46.3%). Moreover, intra-abdominal P. aeruginosa and Candida spp. were isolated more frequently during left-side resections than during right-side operations in patients with peritonitis (15.8% vs. 6.3%, p = 0.02 and 14.3% vs. 5.3%, p = 0.02, respectively). CONCLUSIONS Our results indicate that differences exist in the distribution of pathogens after left- or right-side colorectal resections. Our data further suggest that gram-positive cocci play an important role in SSIs occurring after colorectal resections; therefore, antibiotic prophylaxis should emphasize their coverage. Further, enterococcal coverage may be especially advantageous during left-side resections.
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Affiliation(s)
- Julius Pochhammer
- Department of Visceral, General, and Thoracic Surgery, Marienhospital Stuttgart , Stuttgart, Germany
| | - Joachim Köhler
- Department of Visceral, General, and Thoracic Surgery, Marienhospital Stuttgart , Stuttgart, Germany
| | - Michael Schäffer
- Department of Visceral, General, and Thoracic Surgery, Marienhospital Stuttgart , Stuttgart, Germany
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Pochhammer J, Kramer A, Schäffer M. [Enterococci and surgical site infections : Causal agent or harmless commensals?]. Chirurg 2018; 88:377-384. [PMID: 28233041 DOI: 10.1007/s00104-017-0388-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The role of enterococci in the context of peritonitis and surgical site infections (SSI) has not yet been definitively clarified but enterococci are being detected more frequently. Numerous resistances reduce the available antibiotic options. OBJECTIVE This article gives an overview of the pathogenic importance of enterococci and of current recommendations for therapy and prophylaxis. On the basis of our own data we discuss the relevance of enterococci for SSI. MATERIAL AND METHODS All colorectal resections carried out between January 2008 and September 2016 were retrospectively documented. Revision surgery, SSI and intra-abdominally or subcutaneously detected pathogens were recorded. RESULTS A total of 2713 interventions were evaluated with 28.3% having primary peritonitis. In 587 patients (21.6%) SSI followed, and pathogen determination was possible in 431 cases (73.4%). Enterococci were frequently found in re-operations (58.4%) and SSI (46.1%), with E. faecalis and E. faecium in approximately equal proportions. If intra-abdominal enterococci were detectable in patients with primary peritonitis, it was more common to develop SSI and enterococci were more frequently detected subcutaneously. Enterococci in SSI were found to be significantly more frequent in left hemicolectomies as well as in pre-existing renal insufficiency. CONCLUSION It can be inferred that enterococci are not adequately covered by commonly used perioperative antibiotic therapy or preoperative prophylaxis, which increases the risk for SSI by enterococci. This could be favored by selection of these pathogens due to the use of antibiotics without enterococcal efficacy (e. g. cephalosporins). The consideration in the choice of perioperative antibiotic prophylaxis by the additional administration of ampicillin or vancomycin could be advantageous.
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Affiliation(s)
- J Pochhammer
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Marienhospital Stuttgart, Vinzenz von Paul Kliniken, Böheimstr. 39, 70199, Stuttgart, Deutschland.
| | - A Kramer
- Institut für Hygiene und Umweltmedizin, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - M Schäffer
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Marienhospital Stuttgart, Vinzenz von Paul Kliniken, Böheimstr. 39, 70199, Stuttgart, Deutschland
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Rutkowski A, Pietrzak L, Kryński J, Zając L, Bednarczyk M, Olesiński T, Szpakowski M, Saramak P, Pierzankowski I, Hevelke P, Surowski P, Bujko K. The gentamicin-collagen implant and the risk of distant metastases of rectal cancer following short-course radiotherapy and curative resection: the long-term outcomes of a randomized study. Int J Colorectal Dis 2018; 33:1087-1096. [PMID: 29656304 PMCID: PMC6060799 DOI: 10.1007/s00384-018-3045-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE A previous randomized study conducted by our group showed that application of gentamicin-collagen implant (GCI) into the pelvic cavity after total mesorectal excision (TME) reduced the incidence of distant metastases. Therefore, we decided to conduct a confirmatory study. METHODS Patients with rectal cancer were included in the study if they met the following criteria: adenocarcinoma of the rectum, preoperative short-term radiotherapy (5 × 5 Gy), and WHO performance score 0-1. RESULTS One hundred seventy-six patients were randomly assigned either to an experimental group in which GCI was applied (n = 81) or to a control group without GCI (n = 81). Median follow-up was 80 months. Cumulative incidence of distant metastases at 5 years was higher in the control group compared to the experimental group: 23.5 vs 8.6% (HR 2.4 [95% CI 1.1-5.5], P = 0.005). Overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) did not differ between the experimental group and the control group: HR 0.95 [95% CI 0.55-1.70], P = 0.864; HR 0.85 [95% CI 0.50-1.45], P = 0.548, and HR 0.5 [95%CI 0.22-1.22], P = 0.093, respectively. The predefined by the protocol subgroup analysis for yp stage III disease showed better DFS in the experimental group compared to the control group; HR 0.47 [95%CI 0.23-0.97], P = 0.042). CONCLUSIONS The results confirmed our previous finding that GCI applied in the pelvis significantly reduced the rate of distant metastases in patients after radical rectal cancer resection.
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Affiliation(s)
- Andrzej Rutkowski
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Oncology Center, W. K. Roentgena 5, 02-781 Warsaw, Poland
| | - Lucyna Pietrzak
- Department of Radiotherapy, Maria Sklodowska-Curie Oncology Center, Warsaw, Poland
| | - Jacek Kryński
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Oncology Center, W. K. Roentgena 5, 02-781 Warsaw, Poland
| | - Leszek Zając
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Oncology Center, W. K. Roentgena 5, 02-781 Warsaw, Poland
| | - Mariusz Bednarczyk
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Oncology Center, W. K. Roentgena 5, 02-781 Warsaw, Poland
| | - Tomasz Olesiński
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Oncology Center, W. K. Roentgena 5, 02-781 Warsaw, Poland
| | - Marek Szpakowski
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Oncology Center, W. K. Roentgena 5, 02-781 Warsaw, Poland
| | - Piotr Saramak
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Oncology Center, W. K. Roentgena 5, 02-781 Warsaw, Poland
| | - Ireneusz Pierzankowski
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Oncology Center, W. K. Roentgena 5, 02-781 Warsaw, Poland
| | - Piotr Hevelke
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Oncology Center, W. K. Roentgena 5, 02-781 Warsaw, Poland
| | - Piotr Surowski
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Oncology Center, W. K. Roentgena 5, 02-781 Warsaw, Poland
| | - Krzysztof Bujko
- Department of Radiotherapy, Maria Sklodowska-Curie Oncology Center, Warsaw, Poland
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Konstantelias AA, Polyzos KA, Falagas ME. Gentamicin-Collagen Sponges for the Prevention of Surgical Site Infections: A Meta-Analysis of Randomized Controlled Trials. Surg Infect (Larchmt) 2016; 17:601-9. [PMID: 27441956 DOI: 10.1089/sur.2016.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To study the effectiveness of gentamicin-collagen sponges (GCS) for the prevention of surgical site infections (SSIs). METHODS A systematic search of the PubMed and Scopus databases was performed (up to April 2015) to identify randomized controlled trials evaluating the efficacy of GCS for the prevention of SSIs. A random effects model was applied. RESULTS Twenty-one RCTs (8,472 patients) were included. Gentamicin-collagen sponges were associated with a lower risk of SSIs (risk ratio [RR] 0.65; 95% confidence interval [CI] 0.49-0.84). Based on Jadad scores, a lower risk for the development of SSI was presented in lower-quality studies (Jadad <3; RR 0.44; 95% CI 0.27-0.71), but no difference was observed in high-quality studies (Jadad ≥3; RR 0.77; 95% CI 0.58-1.02). No difference was observed in all-cause deaths in the GCS group compared with the control group (RR 0.77; 95% CI 0.56-1.06). CONCLUSIONS When analyzing lower-quality studies or only clean procedures, GCS significantly reduced the risk of SSI. Further high-quality randomized studies are needed to confirm the benefit of GCS for lowering mortality rates.
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Affiliation(s)
- Athanasios A Konstantelias
- 1 Alfa Institute of Biomedical Sciences (AIBS) , Athens, Greece .,2 Department of Neurosurgery, Agios Savvas Regional Cancer Hospital , Athens, Greece
| | - Konstantinos A Polyzos
- 1 Alfa Institute of Biomedical Sciences (AIBS) , Athens, Greece .,3 Department of Medicine, Karolinska Institutet and University Hospital , Stockholm, Sweden
| | - Matthew E Falagas
- 1 Alfa Institute of Biomedical Sciences (AIBS) , Athens, Greece .,4 Department of Medicine-Infectious Diseases, Iaso General Hospital , Athens, Greece .,5 Department of Medicine, Tufts University School of Medicine , Boston, Massachusetts
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Musters GD, Burger JWA, Buskens CJ, Bemelman WA, Tanis PJ. Local Application of Gentamicin in the Prophylaxis of Perineal Wound Infection After Abdominoperineal Resection: A Systematic Review. World J Surg 2016; 39:2786-94. [PMID: 26170157 PMCID: PMC4591195 DOI: 10.1007/s00268-015-3159-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Use of topical antibiotics to improve perineal wound healing after abdominoperineal resection (APR) is controversial. The aim of this systematic review was to determine the impact of local application of gentamicin on perineal wound healing after APR. METHODS The electronic databases Pubmed, EMBASE, and Cochrane library were searched in January 2015. Perineal wound outcome was categorized as infectious complications, non-infectious complications, and primary perineal wound healing. RESULTS From a total of 582 articles, eight studies published between 1988 and 2012 were included: four randomized controlled trials (RCTs), three comparative cohort studies, and one cohort study without control group. Gentamicin was administered using sponges (n = 3), beads (n = 4), and by local injection (n = 1). There was substantial heterogeneity regarding underlying disease, definition of outcome parameters and timing of perineal wound evaluation among the included studies, which precluded meta-analysis with pooling. Regarding infectious complications, three of six evaluable studies demonstrated a positive effect of local application of gentamicin: one of four RCTs and both comparative cohort studies. Only two RCTs reported on non-infectious complications, showing no significant impact of gentamicin sponge. All three comparative cohort studies demonstrated a significantly higher percentage of primary perineal wound healing after local application of gentamicin beads, but only one out of three evaluable RCTs did show a positive effect of gentamicin sponges. CONCLUSION Currently available evidence does not support perineal gentamicin application after APR.
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Affiliation(s)
- G D Musters
- Department of Surgery, Academic Medical Center, University of Amsterdam, Post box 22660, 1105 AZ, Amsterdam, The Netherlands.
| | - J W A Burger
- Department of Surgery, Erasmus Medical Center/Daniel den Hoed, Post box 5201, 3008 AE, Rotterdam, The Netherlands.
| | - C J Buskens
- Department of Surgery, Academic Medical Center, University of Amsterdam, Post box 22660, 1105 AZ, Amsterdam, The Netherlands.
| | - W A Bemelman
- Department of Surgery, Academic Medical Center, University of Amsterdam, Post box 22660, 1105 AZ, Amsterdam, The Netherlands.
| | - P J Tanis
- Department of Surgery, Academic Medical Center, University of Amsterdam, Post box 22660, 1105 AZ, Amsterdam, The Netherlands.
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Meta-analysis of local gentamicin for prophylaxis of surgical site infections in colorectal surgery. Int J Colorectal Dis 2016; 31:393-402. [PMID: 26614505 DOI: 10.1007/s00384-015-2454-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE Surgical site infections (SSIs) following colorectal surgery is common, and local application of gentamicin for SSIs in the surgery remains controversial. OBJECTIVE To identify whether local application of gentamicin reduces incidence of SSIs in colorectal surgery. METHODS PubMed, Embase, the Cochrane Library, and Science Citation Index were searched for relevant randomized controlled trials (RCTs) and reference list up to November 2014. Two independent reviewers screened the records from the electronic databases, selected relevant studies, assessed the methodological quality, and extracted the data from included articles. Stata 12.0 was used to conduct a pooled analysis for main outcomes. RESULTS Eight relevant randomized controlled trials with a total of 1685 patients were included in the meta-analysis. All included studies were of moderate to high quality by the Cochrane Collaboration's tool for assessing risk of bias. There was no significant difference being found in the total pooled results for wound infection (relative risk (RR) 0.73, 95% confidence interval (CI) 0.47 to 1.12) and organ space infection (RR 0.90, 95% CI 0.51 to 1.59). However, subgroup analysis showed that the significant decrease of wound infection was associated with the population in the Western Europe (RR 0.60, 95% CI 0.42 to 0.87) and follow-up periods of 30 days (RR 0.63, 95% CI 0.42 to 0.94). CONCLUSIONS Local application of gentamicin significantly reduced incidence of wound infection following colorectal surgery in Western Europe, and it was also associated with lower risk of wound infection during follow-up period of 30 days. However, its effectiveness on prophylaxis of perineal wound infection and organ space infection still lacked evidence.
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