Summary
Background
There is no consensus on the use of prophylactic intraoperative wound irrigation (pIOWI)
for reducing surgical-site infections (SSIs), particularly surgical incisional wounds,
and opinions are divided on whether an antibiotic should be mixed with the solution
used for incisional wound irrigation. No large, reliable cohort studies or meta-analyses
of pIOWI for surgical incisional wounds were found in PubMed or Embase.
Methods
We searched the PubMed, Embase, Cochrane Library, Insight, Scopus, and Web of Science
databases for primary research articles investigating the relevance of pIOWI with
antibiotics for SSIs. The initial search was limited to human studies published before
January 2022, which were indexed as randomized controlled trials (RCTs); clinical
trials; or observational, cross-sectional, or cohort studies. We used R statistical
software version 4.1.2 for this meta-analysis.
Results
The odds ratio of the random-effects model was 0.519 [95% confidence interval (CI);
0.311, 0.864, P-value < 0.0117], indicating that the intervention had a statistically
significant effect on surgical complications. To examine the heterogeneity of the
entire study, we performed statistical analysis (τ2 (tau square) = 0.4175 [0.0732; 2.8178]; τ (tau) = 0.6461 [0.2706; 1.6786]; Higgins’
I2 = 64.0% [34.8%; 80.1%]; and H = 1.67 [1.24; 2.24]).
Conclusions
Many studies have shown that inclusion of antibiotics in the irrigation solution significantly
lowers the rate of soft-tissue-related SSIs, but those studies contain both heterogeneity
and many biases. Further large, prospective RCTs only limited to incisional SSIs and
excluding other variables and biases in the field of plastic surgery are needed.
Keywords
Abbreviations:
pIOWI (prophylactic intraoperative wound irrigation), SSI (surgical site infection), RCT (randomized controlled trial), OR (odds ratio), IOWI (intraoperative wound irrigation), CDC (Centers for Disease Control and Prevention), CI (confidence interval), SMD (standardized mean difference), MINORS (Methodological Index for Nonrandomized Studies), CHX (chlorhexidine), MRSA (methicillin-resistant Staphylococcus aureus), VRE (vancomycin-resistant enterococci), HIV (human immunodeficiency virus)To read this article in full you will need to make a payment
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References
- Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis.Lancet. 2011; 377: 228-241
- Multistate point-prevalence survey of health care-associated infections.N Engl J Med. 2014; 370: 1198-1208
- Surgical site infection: incidence and impact on hospital utilization and treatment costs.Am J Infect Control. 2009; 37: 387-397
- The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs.Infect Control Hosp Epidemiol. 1999; 20: 725-730
- Systematic review and meta-analysis of randomized controlled trials evaluating prophylactic intra-operative wound irrigation for the prevention of surgical site infections.Surg Infect (Larchmt). 2017; 18: 508-519
- Survey of intraoperative povidone-iodine application to prevent surgical site infection in a French region.J Hosp Infect. 2011; 77: 363-364
- Intra-operative peritoneal lavage–who does it and why?.Ann R Coll Surg Engl. 2005; 87: 255-258
- Intra-operative wound irrigation to reduce surgical site infections after abdominal surgery: a systematic review and meta-analysis.Langenbecks Arch Surg. 2015; 400: 167-181
- Prevention and treatment of surgical site infection: summary of NICE guidance.BMJ. 2008; 337: a1924
- Strategies to prevent surgical site infections in acute care hospitals: 2014 update.Infect Control Hosp Epidemiol. 2014; 35: S66-S88
- Surgical wound irrigation: a call for evidence-based standardization of practice.Am J Infect Control. 2014; 42: 525-529
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.J Clin Epidemiol. 2009; 62: 1006-1012
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.BMJ. 2009; 339: b2535
- Guideline for prevention of surgical site infection, 1999. Centers for disease control and prevention (CDC) hospital infection control practices advisory committee.Am J Infect Control. 1999; 27 (quiz 3-4; discussion 96): 97-132
- QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies.Ann Intern Med. 2011; 155: 529-536
- Methodological index for non-randomized studies (minors): development and validation of a new instrument.ANZ J Surg. 2003; 73: 712-716
- Topical ampicillin in addition to a systemic antibiotic prophylaxis in elective colorectal surgery. A prospective randomized study.Dis Colon Rectum. 1985; 28: 804-806
- Prophylactic antibiotics in vascular surgery. Topical, systemic, or both?.Ann Surg. 1980; 192: 356-364
- Effect of gentamicin lavage of the axillary surgical bed after lymph node dissection on drainage discharge volume.Breast. 2013; 22: 874-878
- Infections of breast implants in aesthetic breast augmentations: a single-center review of 3,002 patients.Aesthetic Plast Surg. 2007; 31: 325-329
- Breast pocket irrigation with antibiotic solution at implant insertion: a systematic review and meta-analysis.Aesthetic Plast Surg. 2018; 42: 1179-1186
- Povidone-iodine combined with antibiotic topical irrigation to reduce capsular contracture in cosmetic breast augmentation: a comparative study.Aesthet Surg J. 2013; 33: 675-680
- Protective effect of topical antibiotics in breast augmentation.Plast Reconstr Surg. 2009; 124: 629-634
- Intraoperative anaphylaxis associated with bacitracin irrigation.Am J Health Syst Pharm. 2011; 68: 323-327
- The Evolving Threat of Antimicrobial resistance: Options for Action.World Health Organization, Geneva2012
- Antibiotic resistance-the need for global solutions.Lancet Infect Dis. 2013; 13: 1057-1098
- Understanding the mechanisms and drivers of antimicrobial resistance.Lancet. 2016; 387: 176-187
- Antiseptic resistance: what do we know and what does it mean?.Clin Lab Sci. 2005; 18: 181-187
- Antiseptic "resistance": real or perceived threat?.Clin Infect Dis. 2005; 40: 1650-1656
- Healthcare associated infection: novel strategies and antimicrobial implants to prevent surgical site infection.Ann R Coll Surg Engl. 2010; 92: 453-458
- An experimental evaluation of antiseptic wound irrigation.J Hosp Infect. 1984; 5: 181-188
- Reducing the risk of surgical site infections: does chlorhexidine gluconate provide a risk reduction benefit?.Am J Infect Control. 2013; 41: S49-S55
- A systems approach to preoperative surgical patient skin preparation.Am J Infect Control. 2004; 32: 57-62
- A bundle of care to reduce colorectal surgical infections: an Australian experience.J Hosp Infect. 2011; 78: 297-301
- Colorectal surgery surgical site infection reduction program: a national surgical quality improvement program–driven multidisciplinary single-institution experience.J Am Coll Surg. 2013; 216: 23-33
- The preventive surgical site infection bundle in colorectal surgery: an effective approach to surgical site infection reduction and health care cost savings.JAMA Surg. 2014; 149: 1045-1052
Article info
Publication history
Published online: October 17, 2022
Accepted:
October 11,
2022
Received:
June 9,
2022
Identification
Copyright
© 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
