Using preoperative colon preparation to prevent surgical site infection
15/11/10 | Complex wounds, Infection | Donald E Fry
When it comes to the efficacy of oral antibiotic bowel preparation and the appropriate use of systemic antibiotics there are many unanswered questions. For example, is there a role for the intraoperative application of antibiotics or antiseptics to the surgical site? Can intraoperative pulsed-lavage reduce the microbial burden on the wound interface before closure? Could closed suction drains within a closed surgical incision reduce infection rates, especially in patients with a large body mass index (BMI)? What is the role of delayed primary closure or secondary closure in the wound where obvious contamination has occurred, or in the circumstance of emergent colonic resection where considerable contamination is encountered from pre-existent perforation? And are immediate negative pressure wound dressings appropriate in the open contaminated wound?
These and many other questions still continue to confront clinicians involved in colorectal surgery. In this author's opinion, considerable evidence supports the routine use of oral antibiotic bowel preparation in conjunction with effective mechanical preparation and this regimen deserves a broader application in practice.
Donald E Fry is Adjunct Professor of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois and Emeritus Professor of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico.
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