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Evaluation of antibiotic pressurized pulse lavage for contaminated retromuscular abdominal wall reconstruction
Arnab Majumder1, Heidi J Miller1, Parita Patel1
1Department of Surgery, UH Comprehensive Hernia Center, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
Background:
Despite patient risk factors such as diabetes and obesity, contamination during surgery remains a significant cause of infections and subsequent wound morbidity. Pressurized pulse lavage (PPL) has been utilized as a method to reduce bacterial bioburden with promising results in many fields. Although existing methods of lavage have been utilized during abdominal operations, no studies have examined the use of PPL during complex hernia repair.
Methods:
Patients undergoing abdominal wall reconstruction (AWR) in clean-contaminated or contaminated fields with antibiotic PPL, from January 2012 to May 2013, were prospectively evaluated. Primary outcome measures studied were conversion of retrorectus space culture from positive to negative after PPL and 30-day surgical site infection (SSI) rate.
Results:
A total of 56 patients underwent AWR, with 44 patients (78.6 %) having clean-contaminated fields and 12 patients (21.4 %) having contaminated ones. Twenty-two patients (39.3 %) had positive pre-PPL cultures, 18 of which (81.8 %) converted to negative cultures after PPL. Eleven patients (19.6 %) developed SSIs. Those with persistently positive cultures after PPL had the highest rate of SSI, where two out of four patients (50.0 %) developed an SSI. Contrastingly, only 5 of 18 patients (27.8 %) who converted from a positive to negative culture after PPL developed an SSI.
Conclusion:
Our findings demonstrate that antibiotic PPL is an effective method to reduce bacterial bioburden during AWR in clean-contaminated and contaminated fields. While complete conversion and eradication of SSI were not achieved, we believe that PPL may be a useful adjunct to standard operative asepsis in preventing prosthetic contamination during contaminated AWR.
Insights
Antibiotic pressurized pulse lavage (PPL) effectively reduced bacterial contamination in abdominal wall reconstruction (AWR) surgery. While not eliminating surgical site infections (SSIs), PPL aided in converting positive cultures to negative, potentially lowering SSI rates.
Area of Science:
- Surgical Innovation
- Infectious Disease Prevention
- Wound Healing
Background:
- Surgical site infections (SSIs) are a significant complication in abdominal wall reconstruction (AWR), particularly in contaminated fields.
- Patient risk factors like diabetes and obesity exacerbate infection risks.
- Pressurized pulse lavage (PPL) is a promising technique for reducing bacterial bioburden in various surgical settings.
Purpose of the Study:
- To evaluate the efficacy of antibiotic PPL in reducing bacterial bioburden during AWR in clean-contaminated and contaminated surgical fields.
- To assess the impact of PPL on converting positive retrorectus space cultures to negative.
- To determine the 30-day surgical site infection (SSI) rate following AWR with antibiotic PPL.
Main Methods:
- A prospective study evaluated patients undergoing AWR with antibiotic PPL between January 2012 and May 2013.
- Patients were categorized by surgical field contamination (clean-contaminated or contaminated).
- Primary outcomes included retrorectus space culture conversion (positive to negative) and 30-day SSI rates.
Main Results:
- Of 56 AWR patients, 44 (78.6%) had clean-contaminated and 12 (21.4%) had contaminated fields.
- Twenty-two patients (39.3%) had positive pre-PPL cultures, with 18 (81.8%) converting to negative post-PPL.
- Eleven patients (19.6%) developed SSIs; those with persistently positive cultures had a 50% SSI rate, versus 27.8% for those converting to negative.
Conclusions:
- Antibiotic PPL effectively reduces bacterial bioburden during AWR in contaminated settings.
- PPL demonstrated a significant conversion rate of positive to negative cultures.
- PPL may serve as a valuable adjunct to standard aseptic techniques for preventing prosthetic contamination in contaminated AWR.
