The protective role of intraperitoneal antibiotic irrigation in contaminated penetrating wounds of the cecum.

Neomycin (500 mg.), polymyxin (500,000 U.), and bacitracin (50,000 U.) in one liter of saline, used as an abdominal irrigation solution, protects dogs against intraperitoneal infection and wound infections and markedly curtails adhesion formation after peritoneal contamination with cecal contents. Dogs treated with topical antibiotics after cecal puncture and local contamination were almost identical to control dogs without contamination. Equal volumes of saline irrigation offered no therapeutic advantage despite the theoretical benefit of diluting the bacterial and chemical challenge. Reported results are statistically significant (rho less than or equal to 0.05).     

Intraoperative anaphylaxis after irrigation with bacitracin: case report

We report a case of anaphylaxis caused by irrigation with a bacitracin solution during lumbar laminectomy. The patient had been exposed to bacitracin during a previous anterior cervical discectomy. We recommend avoiding the use of irrigation solutions containing bacitracin in patients with previous systemic exposure to this antibiotic.     

Prevention of infection after total joint replacement. Experiments with a canine model

An experiment was done in dogs to evaluate how efficient each of several techniques was in preventing infection after a total joint arthroplasty. The techniques that were studied were intraoperative irrigation with saline solution or with antimicrobial solution, perioperative systemic administration of antibiotics, and the addition of an antibiotic to bone cement. Irrigation with saline solution did not reduce the incidence of infection. A slight reduction was found after irrigation with neomycin solution and after systemic administration of cefazolin solution. The use of bone cement containing gentamicin caused a statistically significant reduction in the rate of infection; in fact, no infection developed in any animal that was treated with bone cement containing gentamicin. There was excellent but not absolute correlation between findings on culture that indicated the presence of infection and histological evidence of inflammation.     

Bacitracin irrigation: a cause of anaphylaxis in the operating room

Implications: We report a unique case of acute anaphylaxis after mediastinal irrigation with a dilute bacitracin solution.     

Comparison of soap and antibiotic solutions for irrigation of lower-limb open fracture wounds. A prospective, randomized study

BACKGROUND: Irrigation of open fracture wounds is a commonly performed procedure, and irrigation additives have been used in an attempt to reduce the risk of infection. In vitro and animal studies have suggested that irrigation with detergent solution is more effective than irrigation with a solution containing antibiotic additives. This study was performed to compare the efficacy of those two solutions in the treatment of open fractures in humans. METHODS: Adult patients with an open fracture of the lower extremity were prospectively randomized to receive irrigation with either a bacitracin solution or a nonsterile castile soap solution. The patients were followed clinically to assess for the development of infection, healing of the soft-tissue wound, and union of the fracture. RESULTS: Between 1995 and 2002, 400 patients with a total of 458 open fractures of the lower extremity were entered into the study. One hundred and ninety-two patients were assigned to the bacitracin group (B), and 208 were assigned to the castile soap group (C). Outcomes were available for 171 patients with a total of 199 fractures in group B and 180 patients with a total of 199 fractures in group C. The mean duration of follow-up was 500 days. There was no difference between groups B and C in terms of gender, the Gustilo-Anderson grade of the open fracture, the time between the injury and the irrigation, smoking, or alcohol use. There were significant differences in the mean age (thirty-eight compared with forty-two years, p = 0.01), duration of follow-up (560 compared with 444 days, p = 0.01), prevalence of hypotension (23% compared with 14%, p = 0.04), and duration of treatment with intravenous antibiotics (eleven compared with nine days, p = 0.02). An infection developed at thirty-five (18%) of the 199 fracture sites in group B and at twenty-six (13%) of the 199 fracture sites in group C. This difference was not significant (p = 0.2). Bone-healing was delayed for forty-nine (25%) of the 199 group-B fractures and forty-six (23%) of the 199 group-C fractures (p = 0.72). Wound-healing problems occurred in association with nineteen group-B fractures (9.5%) and eight group-C fractures (4%). This difference was significant (p = 0.03). CONCLUSIONS: Irrigation of open fracture wounds with antibiotic solution offers no advantages over the use of a nonsterile soap solution, and it may increase the risk of wound-healing problems.     

The absorption of antibiotics from the bladder.

The movement across the bladder epithelium of polymyxin B, bacitracin and neomycin is investigated in the human during postoperative irrigation. No appreciable amounts of these antibiotics enter the systemic circulation by this route.     

Successful resuscitation of a patient who developed cardiac arrest from pulsed saline bacitracin lavage during thoracic laminectomy and fusion

A patient with a history of T12 burst fracture caused by a fall, and with progressive weakness and sensory loss in the left leg, survived a cardiac arrest after pulsed saline bacitracin lavage irrigation during a posterior spinal fusion.     

Locally administered antibiotics for prophylaxis against surgical wound infection. An in vivo study

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 x 10(5) 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.     

Experimental pyelonephritis in dogs. Result of urinary infection and vesicoureteral reflux

An experimental model of chronic pyelonephritis was produced in dogs due to the effect of urinary infection and reflux. The persistent urinary infection was spontaneous in our epiziotomized dogs, since induced bladder infection by inoculation of Escherichia coli failed to become persistent in 8 of the 10 dogs. After an average of 36.4 weeks of infection and refux, only the histopathologic evidence of chronic pyelonephritis was present.     

The efficacy and risks of using povidone-iodine irrigation to prevent surgical site infection: an evidence-based review

Introduction

Surgical site infection is a serious complication of surgery. This evidence-based review sought to determine the efficacy and risks of using povidone-iodine irrigation to prevent surgical site infection.

Methods

We searched MEDLINE and EMBASE for randomized controlled trials (RCTs) or comparative studies only (level of evidence I–III).

Results

Of the 15 included studies, all of which were level I or level II evidence (11 RCTs and 4 prospective comparative studies), 10 found povidone-iodine irrigation to be significantly more effective at preventing surgical site infection than the comparison interventions of saline, water or no irrigation. No significant risks were associated with the use of povidone-iodine irrigation other than increased postoperative serum iodine.

Conclusion

Povidone-iodine irrigation is a simple and inexpensive solution with the potential to prevent surgical site infection.     

The effects of pulsed fluid irrigation on bony ingrowth in porous polyethylene implants

Twelve adult dogs were used to evaluate the effect of pulsed isotonic saline irrigation on bony ingrowth. The distal supracondylar ridge of the knee was transected. Six dogs had the area irrigated with a pulsed lavage system for 15 sec and six dogs did not. A porous piece of polyethylene was then stapled to the cancellous surface. Three of each were evaluated histologically at 3 weeks and 6 weeks. The pulsed irrigation significantly decreased the depth of bone penetration into the sections of polyethylene.     

Arthroscopic irrigation and debridement of infected total knee arthroplasty: report of two cases

Various methods have been described for the treatment of the acutely infected total knee arthroplasty. These include antibiotic suppression, open debridement and irrigation, exchange arthroplasty, resection arthroplasty, arthrodesis, and amputation. A method not frequently reported is arthroscopic irrigation and debridement. Two cases of acutely infected total knee arthroplasty treated with arthroscopic irrigation and debridement are presented. In both cases there was a benign postoperative course averaging five months. Both infections were secondary to hematogenous seeding from a distant focus of infection. The patients presented within approximately 12 h after the onset of knee symptoms and were taken for arthroscopic irrigation and debridement within 12 h after presentation. Gram-positive organisms sensitive to the antibiotics being used were cultured in both. Postoperative knee function and range of motion returned rapidly and disability was minimal. At average 30-month follow-up both patients were pain free, had full activity of daily living, and had no clinical or radiographic evidence of infection. Arthroscopic irrigation and debridement appears to be an effective method of treatment in select cases of infected total knee arthroplasty.     

Removal of surface bacteria by irrigation

We examined the efficacy of various irrigation solutions delivered through a power irrigator to remove bacteria from three different surfaces. Titanium, stainless-steel, and cortical bone surfaces were coated with three different bacterial species: Staphylococcus aureus, Pseudomonas aeruginosa, and Staphylococcus epidermidis. They were then irrigated with 1 L of fluid delivered by jet lavage. The fluids tested were normal saline and solutions of bacitracin, neomycin, and soap. One set of specimens was not irrigated, as a control. After irrigation, the specimens were sonicated to remove residual bacteria, and the sonicate was quantitatively cultured to allow evaluation of the amount of residual bacteria on the surface. The results showed that removal of bacteria reflects an interaction between bacterial species, surface characteristics, and irrigation solution. Fewer bacteria were present in all the irrigation groups than in the control. Soap solution was as good as or better than any other solution at removing all three types of bacteria from all three surfaces, although not all of the pairwise comparisons were statistically significant. There was a significant advantage to soap solution over antibiotic irrigant or saline alone in removing Staphylococcus epidermidis from metallic surfaces. The use of a soap solution for irrigation seems to improve the removal of some bacteria from some surfaces in this experimental model and may represent a better type of irrigation additive.     

Tracheal reconstruction with autogenous jejunal microsurgical transfer

Tracheal defects due to stricture formation, tracheomalacia, and neoplasms can present difficult reconstructive problems. Tracheal defects were surgically created in 6 dogs and primarily reconstructed with microsurgical free tissue transfer of autogenous jejunal segments. Primary healing was accomplished in all dogs without severe air leakage or infection. Bronchoscopy demonstrated no substantial secretions or tracheal narrowing. Gross pathological examination of the trachea revealed no evidence of tracheal disruption or infection. Direct measurements revealed no major tracheal narrowing. Microscopic examination demonstrated normal jejunal mucosa with a minimal amount of inflammatory change at the margins of the reconstruction at 6 weeks. Microvascular free tissue transfer of jejunal segments to correct cervical tracheal defects can readily be accomplished with excellent healing and maintenance of the tracheal lumen in dogs.     

Arthroscopy in acute septic knees. Management in pediatric patients

Arthroscopic evacuation, debridement, and irrigation of acute septic knees in children were effective adjuncts in the treatment of this joint infection. Sixteen knees in 16 pediatric patients were treated with arthroscopic management. Ninety-four percent of the knees had sepsis secondary to Staphylococcus aureus. Two immune-suppressed patients (postrenal transplants) had combined S. aureus and Pseudomonas aeruginosa infections. Twenty-five percent of the patients had a foreign body in the joint that was removed arthroscopically. No postoperative irrigation or drainage systems were used. At an average follow-up period of three years, no evidence of persistent or recurrent infection was noted. Roentgenograms showed no evidence of joint or epiphyseal destruction. Because of the low morbidity associated with the procedure, rapid restoration of joint motion and patient mobility was seen in all patients. Arthroscopic debridement of acute septic knees may be carried out in pediatric patients, given appropriate equipment and arthroscopic skills.     

From Road Rash to Top Allergen in a Flash: Bacitracin

Background. Bacitracin is an antibiotic that is produced by Bacillus subtilis , which is used in several types of consumer products, including cosmetics and ophthalmic and cutaneous ointments.
Objective. To call attention to the rising allergic contact dermatitis associated with bacitracin.
Results. Mass usage has resulted in an increasing number of clinically relevant allergic contact dermatitis reactions and near fatal anaphylaxis. The North American Contact Dermatitis Group has recorded its emergence as a leading allergen and continues to monitor the ever-growing allergic reaction rates.
Conclusion. The clinical impact, scientific evidence, and need for medical cost containment all advocate the discontinuation of routine usage of bacitracin in clean surgical wounds.     

Comparison of castile soap, benzalkonium chloride, and bacitracin as irrigation solutions for complex contaminated orthopaedic wounds.

OBJECTIVE: The purpose of the present study was to determine the effects of cleaning a contaminated orthopaedic wound with different classes of wound irrigation solutions. STUDY DESIGN: Rats with a contaminated orthopaedic wound were randomized into treatment groups: normal saline (NS), castile soap (CS), benzalkonium chloride (BzC), bacitracin (Abx), or sequential irrigation with BzC, CS, and NS. INTERVENTION: Pseudomonas aeruginosa [P. aeruginosa; 1 x 10(6) colony-forming units (CFU)], or Staphylococcus aureus (S. aureus; 1 x 10(6) CFU) were placed into a paravertebral wound (containing a wire implant placed through a spinous process) and allowed to incubate for fifteen minutes. The wound was then irrigated with three liters of either NS, 0.05 percent CS, 0.03 percent BzC, Abx (33,000 units per liter) or underwent a sequential irrigation treatment (one liter each of BzC, CS, NS). MAIN OUTCOME MEASUREMENTS: The animals were observed daily for wound complications for fourteen days and then killed, and cultures of the wound were obtained. RESULTS: Pseudomonas aeruginosa: Both CS and the sequential irrigation treatment significantly lowered the rate of positive wound cultures when compared with NS (p < 0.05). Irrigation with BzC resulted in a higher rate of positive wound cultures and complications. The sequential irrigation treatment prevented the wound complications associated with irrigation with BzC alone. Staphylococcus aureus: Only BzC irrigation significantly lowered the rate of positive wound cultures when compared with NS (p < 0.05). CONCLUSION: The rate of positive wound cultures due to P. aeruginosa is effectively reduced by irrigation with CS alone or by the sequential irrigation treatment. When used alone, the antiseptic BzC results in a higher rate of positive wound cultures and wound complications. The wound complications seen with irrigation with BzC alone are prevented by the sequential irrigation treatment (BzC followed by CS and NS). The rate of positive wound cultures in this model due to S. aureus is not decreased by irrigation with CS; however, the rate of positive wound cultures is safely and effectively decreased with the use of BzC.     

Bladder irrigation with chlorhexidine for the prevention of urinary infection after transurethral operations: a prospective controlled study

The value of postoperative bladder irrigation with the antiseptic agent chlorhexidine was assessed in a randomized prospective controlled study of men after transurethral operations. In patients with sterile preoperative urine the incidence of postoperative bacteriuria was 12.8 per cent, compared to 36.7 per cent in control patients. The difference is significant (chi-square 5.54, p less than 0.02). On the other hand, chlorhexidine irrigation did not eliminate pre-existing infection. Small amounts of chlorhexidine were demonstrated in the blood of some patients. There was no evidence of damage to the bladder and no toxic side effects.     

Continuous irrigation of the bladder after prostatectomy: its effect on post-prostatectomy infection

The incidence of post-prostatectomy bacteriuria was measured in patients having no continuous bladder irrigation postoperatively, in those irrigated for 24 hours with chlorhexidine 1/5,000, and in those irrigated with normal saline. The infection rate after saline irrigation was greater than after chlorhexidine, but the infection rates after chlorhexidine irrigation and drainage alone were similar. The infection rate was higher in older patients, in those treated with retropubic rather than transurethral prostatectomies, in those who had postoperative catheters for more than 4 days, and in those admitted in acute retention of urine. The increase in infection rate associated with acute retention was seen only in the group treated with drainage alone postoperatively. Chlorhexidine irrigation appears to reduce the infection rate in these cases.     

Experimental reconstruction of the trachea with free jejunal graft

To evaluate experimentally the usefulness of the jejunum in the correction of extensive tracheal defect, circumferential tracheal defect was surgically created in 31 mongrel dogs and primarily reconstructed with microsurgical free tissue transfer of autogenous jejunal segment. A silicone T tube was inserted to maintain the lumen of the grafted jejunal segment. First, defect of 7 cervical tracheal rings was repaired with untreated 5 cm free jejunal segment in 12 dogs (group 1). Next, a pilot experiment to examine the quantity of intestinal juices from jejunal segments revealed that abrasion and cauterization of the mucosal surface decreased the secretion of intestinal juices, so defect of 7 cervical tracheal rings was repaired with 5 cm free jejunal segment the surface of whose mucosa was abraded and cauterized in 11 dogs (group 2). In all the dogs except two, primary healing was accomplished without air leakage or infection, and gross pathological examination of the trachea and graft revealed no evidence of disruption, infection or granulation. In group 1, 6 of the 12 dogs died of pneumonia or air way obstruction caused by intestinal juices from free jejunal segment within 20 days after the operation. On the other hand, only one of the 11 dogs died of pneumonia at 9 days in group 2. One of the dogs died of air way obstruction caused by mucus at 3 months. Three dogs died of filariasis at 4 weeks, 3 and 7 months, and 5 dogs were sacrificed at 2, 4, 8 weeks and 3 months. Microscopic examination of the graft demonstrated thin jejunal mucosa. The anastomosis was already covered with epithelium by the end of 2 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)