TITLE

Locally Administered Antibiotics for Prophylaxis Against Surgical Wound Infection

AUTHOR(S)
Yarboro, Seth R.; Baum, Elyse J.; Dahners, Laurence E.
PUB. DATE
May 2007
SOURCE
Journal of Bone & Joint Surgery, American Volume;May2007, Vol. 89-A Issue 5, p929
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Currently, the standard for prophylaxis against surgical infection consists of perioperative systemic antibiotics. In this study, we investigated the relative efficacy of various methods of antibiotic delivery for the prevention of surgical wound infections. We hypothesized that sustained release of local antibiotics inside the wound cavity by a drug delivery system would be more effective than systemically administered antibiotics. Methods: Using a rat model, we inoculated a surgical wound in the quadriceps muscle with 8.0 × 105 colony-forming units of Staphylococcus aureus and then administered one of seven types of treatment: no treatment (control), bacitracin irrigation, calcium sulfate flakes, systemic gentamicin, local aqueous gentamicin, local gentamicin-loaded calcium sulfate flakes, and a combination of local gentamicin-loaded calcium sulfate and systemic gentamicin. The seven treatment groups consisted of ten rats each. To further evaluate a trend, the group treated with systemic gentamicin and the one treated with local gentamicin solution were extended to include twenty-five and twenty-seven rats, respectively. At forty-eight hours postoperatively, specimens from the wounds were obtained for quantitative culture. Results: The control group, the group treated with bacitracin irrigation, and the one treated with plain calcium sulfate had very high bacterial counts and high mortality rates while the groups treated with gentamicin had low bacterial counts and a 100% survival rate. Local gentamicin was significantly more effective than systemic gentamicin in reducing bacterial counts. Conclusions: The gentamicin-loaded calcium sulfate flakes did not result in bacterial counts that were significantly lower than those following systemic administration of gentamicin, which refuted our hypothesis. However, gentamicin solution injected directly into the closed wound did result in levels of bacteria that were significantly lower than those following treatment with the systemic gentamicin. Clinical Relevance: We believe that a high initial concentration of locally applied antibiotic inside the wound effectively kills bacteria present in the wound cavity, where systemic antibiotics have poor penetration, suggesting that this method of antibiotic administration may be a desirable adjunct for prophylaxis against infection in surgical wounds.
ACCESSION #
25019635

 

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