Using antimicrobial solution for irrigation in appendicitis to lower surgical site infection rates

Jeremy P. Parcells, Joan P. Mileski, Forrest T. Gnagy, Adriane F. Haragan, William Mileski

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: The use of antimicrobial solutions for irrigation in appendicitis is controversial. Numerous antiseptic and antibiotic solutions have been suggested for use as an intraoperative irrigant. We sought to determine whether there was a difference in postoperative surgical site infections (SSIs) comparing normal saline (.9%), antiseptic solution (Dakin's, .25%), and an antibiotic solution (imipenem 1 mg/mL). Methods: We performed a retrospective study of adult appendectomies from January 1997 through November 2007 at a single institution The data were evaluated by multivariate logistic regression analysis and chi-square test. The incidences of postoperative overall SSI, wound infection, and abdominal abscess were compared. Results: A total of 1,063 cases were identified. Saline (n = 661) had an SSI rate of 9.8% (65/661), a wound infection rate of 7.3% (48/661), and an abdominal abscess rate of 4.2% (28/661). Dakin's (n = 208) had an SSI rate of 20.7% (43/208), a wound infection rate of 15.9% (33/208), and an abdominal abscess rate of 9.1% (19/208). Imipenem (n = 194) irrigation had an SSI rate of .5% (1/194), a wound infection rate of .5% (1/194), and an abdominal abscess rate of .5% (1/194). Conclusions: These results suggest that abdominal irrigation with an antibiotic solution (imipenem 1 mg/mL) is superior to both normal saline and Dakin's solution.

Original languageEnglish (US)
Pages (from-to)875-880
Number of pages6
JournalAmerican Journal of Surgery
Volume198
Issue number6
DOIs
StatePublished - Dec 2009

Fingerprint

Surgical Wound Infection
Appendicitis
Abdominal Abscess
Wound Infection
Imipenem
Local Anti-Infective Agents
Anti-Bacterial Agents
Appendectomy
Chi-Square Distribution
Sodium Chloride
Retrospective Studies
Logistic Models
Regression Analysis
Incidence

Keywords

  • Abdominal abscess
  • Antibiotics
  • Appendectomy
  • Irrigation
  • Perforated appendix
  • Surgical complication
  • Surgical site infection
  • Wound infection

ASJC Scopus subject areas

  • Surgery

Cite this

Using antimicrobial solution for irrigation in appendicitis to lower surgical site infection rates. / Parcells, Jeremy P.; Mileski, Joan P.; Gnagy, Forrest T.; Haragan, Adriane F.; Mileski, William.

In: American Journal of Surgery, Vol. 198, No. 6, 12.2009, p. 875-880.

Research output: Contribution to journalArticle

Parcells, Jeremy P. ; Mileski, Joan P. ; Gnagy, Forrest T. ; Haragan, Adriane F. ; Mileski, William. / Using antimicrobial solution for irrigation in appendicitis to lower surgical site infection rates. In: American Journal of Surgery. 2009 ; Vol. 198, No. 6. pp. 875-880.
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abstract = "Background: The use of antimicrobial solutions for irrigation in appendicitis is controversial. Numerous antiseptic and antibiotic solutions have been suggested for use as an intraoperative irrigant. We sought to determine whether there was a difference in postoperative surgical site infections (SSIs) comparing normal saline (.9{\%}), antiseptic solution (Dakin's, .25{\%}), and an antibiotic solution (imipenem 1 mg/mL). Methods: We performed a retrospective study of adult appendectomies from January 1997 through November 2007 at a single institution The data were evaluated by multivariate logistic regression analysis and chi-square test. The incidences of postoperative overall SSI, wound infection, and abdominal abscess were compared. Results: A total of 1,063 cases were identified. Saline (n = 661) had an SSI rate of 9.8{\%} (65/661), a wound infection rate of 7.3{\%} (48/661), and an abdominal abscess rate of 4.2{\%} (28/661). Dakin's (n = 208) had an SSI rate of 20.7{\%} (43/208), a wound infection rate of 15.9{\%} (33/208), and an abdominal abscess rate of 9.1{\%} (19/208). Imipenem (n = 194) irrigation had an SSI rate of .5{\%} (1/194), a wound infection rate of .5{\%} (1/194), and an abdominal abscess rate of .5{\%} (1/194). Conclusions: These results suggest that abdominal irrigation with an antibiotic solution (imipenem 1 mg/mL) is superior to both normal saline and Dakin's solution.",
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