Comparative Study for Effectiveness of Preoperative Intraincisional Antibiotic Infiltration in Preventing Surgical site Infections in Abdominal Surgery

Abstract

Introduction: surgical site infections cause increased post-operative morbidity. In initial days antibiotics were used to be given post-operatively for longer durations which led to little reduction of surgical site infections. With advent of intravenous pre-operative antibiotic administration, the incidence of SSIs reduced significantly. The antibiotic concentration rises in blood and later reaches at the wound site the where the concentration of antibiotic is lower. With modern aseptic techniques and intravenous pre-operative antibiotic administration the incidence of SSI has reduced significantly but is almost constant for many years this has led to search for innovative efforts to reduce the SSI, in view of this pre-incisional infiltration of antibiotics seems to a good candidate. Various studies have shown the measured local antibiotic level to be considerably higher in the patients getting local infiltration of antibiotics than the patients getting intravenous antibiotics alone. Aim: To assess and compare reduction in incidence of surgical site infection between patients receiving parenteral antibiotics to patients receiving both parenteral and pre-incisional antibiotic infiltration of the wound site. Materials and Methods: 138 patients were enrolled in the assuming Alpha error (5%) power (80%) and confidence interval (95%), randomization was done by computer generated random tables for different sub groups. Patients were divided in two main groups. Group I received both pre-incisional local and parenteral antibiotics, Group II received only parenteral antibiotics, both the groups were further divided into 3 group each as clean, clean contaminated, contaminated and dirty groups. Inclusion criteria: Patients operated in both emergency and elective operation theatres, patients who underwent abdominal surgeries, procedure lasted less than 3 hours, patients who developed infection within 30 days of surgery. Exclusion criteria: patients with skin infections and infection at other site, patients with psoriasis and other exanthema disorders. Results: Incidence of SSI was significantly less in group receiving pre-operative intra-incisional antibiotics as compared to the group receiving only intravenous antibiotics. Conclusions: SSI occurred in 25 out of 92 males while 5 out of 46 females which is statistically significant. Poorly controlled diabetes, smoking and poor nutritional status were associated with higher rate of SSI. SSI was significantly more in emergency patients as compared to elective cases.