Podcast: Topical antibiotics (applied to the skin) for preventing surgical site infection in wounds that are stitched or held together another way

One of the complications after surgery, is that the patient might develop an infection at the site of the wound. Clare Heal from the James Cook University in Mackay in Australia and colleagues have investigated the effects of applying antibiotics to the skin to prevent this in a new Cochrane Review, published in November 2016. She tells us what they found in this podcast.

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John: One of the complications after surgery, is that the patient might develop an infection at the site of the wound. Clare Heal from the James Cook University in Mackay in Australia and colleagues have investigated the effects of applying antibiotics to the skin to prevent this in a new Cochrane Review, published in November 2016. She tells us what they found in this podcast.

Clare: Surgical site infections are usually cause by the presence of bacteria at wound sites following the surgery and they can increase healthcare costs, delay wound healing and cause pain. Antibiotics kill bacteria or prevent them from developing, and can be taken by mouth, intravenously into the veins, or applied directly to the skin, or topically. Using antibiotics topically might be beneficial because they will then act only on the area of the body where they are applied, and there is less likelihood of unwanted effects that affect the whole body, such as nausea and diarrhoea. Topical antibiotics are also thought to reduce the chances of bacterial resistance, in which bacteria change to become resistant to medication. However, topical antibiotics can also have unwanted effects, the most common being an allergic reaction on the skin called contact dermatitis. This can cause redness, itching and pain at the site where the topical antibiotic was applied.We searched for studies of the use of topical antibiotics on surgical wounds healing by primary intention, which means that the edges of the wound are held closely together, usually with stitches, so that they can heal more easily. We found 14 studies with nearly 6500 participants that had compared topical antibiotics with no treatment, or with antiseptics, and judged the overall quality of the evidence to be moderate. Combining the results of the studies showed that the risk of having a surgical site infection was probably reduced by applying antibiotics to wounds after surgery, whether compared with an antiseptic, or to no antibiotic treatment. As infection is a relatively rare event after surgery, the actual reduction in the incidence of infection was about 4% in the trials that compared a topical antibiotic with antiseptic, and 2% in those that compared the antibiotic with no treatment. Only four studies reported on allergic contact dermatitis, and there was insufficient evidence to determine whether or not this occurred more often with topical antibiotics than with antiseptics or no treatment.
In summary, the evidence we have reviewed shows that applying antibiotics to surgical wounds probably reduces the risk of infection relative to both no antibiotic and topical antiseptics; but doesn’t allow us to draw conclusions about the effects on adverse outcomes for the patient or on antibiotic resistance.

John: Thanks Clare. If you would like to delve deeper into this evidence, you can find the review online. Go to Cochrane Library dot com and search ‘topical antibiotics and surgical infection’.

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