SLR - July 2011 - Warner Siegle
Reference: S.M. McHugh, C.J Colllins, M.A Corrigan, A.D.K Hill, H. Humphreys. The role of topical antibiotics used as prophylaxis in surgical site infection prevention. J Antimicrob Chemother 2011; 66: 693– 701.
Scientific Literature Review
Reviewed by: Warner Siegle, DPM
Residency Program: Roxborough Memorial Hospital, Philadelphia, PA
Podiatric Relevance:
Through a comprehensive literature review, the authors of this study make recommendations with respect to the use of perioperative topical antibiotics in the fields of orthopedic and dermatologic surgery that may directly impact the podiatric profession.
Methods:
A detailed review of the literature was carried out through searches of peer-reviewed publications over a 30 year period between January 1980 and May 2010. The review was focused solely on the use of topical or local antibiotics as surgical prophylaxis in surgical site infection (SSI) prevention only. In addition, studies assessing antibiotic-impregnated cement, beads or gels for local application were included. It was noted that antibiotic-impregnated devices, grafts or suture materials (e.g. vicryl plus) were excluded, as these are specifically advocated and used to prevent device-related infections and not just SSI.
Results:
The authors found several studies through which recommendation can be adapted to advocate the use of topical antibiotics in podiatric procedures. A meta-analysis of 35659 hip arthroplasty patients showed that the use of antibiotic-impregnated bone cement caused a reduction of post surgical infection from 2.3% to 1.2%. A retrospective observational study of 1085 patients undergoing debridement and stabilization of compound limb fractures showed that gentamicin-impregnated beads caused a reduction of SSI infection from 12% to 3.7%.
In the field of dermatology, a randomized controlled trial of 1014 patients undergoing clean skin lesion excision has a post surgical infection reduction from 11% to 6.6% when treated with chloramphenicol ointment after the procedure. All of the mentioned studies provide statistically significant evidence for the use of local antibiotics in the prophylactic setting.
Conclusions:
Local antibiotic use may be underutilized in preventing post-operative infection in the podiatric patient. Podiatric guided research is needed to correlate these findings with procedures in our own profession. Total ankle arthroplasty is an example of one procedure that could benefit from the use of antibiotic cement. In additional, patients with skin lesions may be suffering from unnecessary post operative infection. The reviewed article provides a template and basis of recommendation for the academically inclined podiatric physician to explore new possibilities in the use of local antibiotic therapy.