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Combined topical povidone-iodine and systemic antibiotics in postappendicectomy wound sepsis
Insights
Topical povidone-iodine did not improve wound sepsis rates in early appendicitis but increased infection risk in late appendicitis, indicating it should be avoided in complex cases.
Area of Science:
- Surgical Infection Prevention
- Clinical Trials in Surgery
Background:
- Appendicitis management often involves antibiotics to prevent surgical site infections.
- The role of topical antiseptics in appendicitis surgery requires further investigation.
Purpose of the Study:
- To evaluate the efficacy of topical povidone-iodine in reducing postoperative wound sepsis in appendicitis patients.
- To compare outcomes between systemic antibiotics alone versus systemic antibiotics with topical povidone-iodine.
Main Methods:
- A randomized controlled trial involving 315 appendicitis patients.
- Patients received either systemic gentamicin and metronidazole or these antibiotics plus topical 1% povidone-iodine.
- Antibiotic regimens were stratified based on appendicitis severity (early vs. late).
Main Results:
- No significant difference in wound sepsis was observed between groups for early appendicitis.
- A statistically significant increase in deep wound sepsis (8/51 vs. 1/52, P=0.03) was noted in patients with late appendicitis who received topical povidone-iodine.
- All infections occurred within two weeks post-operation.
Conclusions:
- Topical 1% povidone-iodine is associated with an increased risk of wound infection in late appendicitis cases.
- The routine use of topical povidone-iodine in appendicitis surgery, particularly for complicated cases, should be reconsidered.
Abstract:
Three hundred and fifteen patients with appendicitis were randomized into two groups. One group received pre-operative systemic gentamicin and metronidazole while the other group received 1 per cent topical povidone-iodine solution in addition to the antibiotics. For early appendicitis including normal and acutely inflamed appendices, only one dose of antibiotics was used. The postoperative wound sepsis was very low in both groups of patients and there was no statistical difference between them. For late appendicitis including gangrenous and perforated appendices, the antibiotics were continued for 7 days. Eight out of 51 patients who had the topical agent developed wound sepsis compared with one out of 52 patients who received no topical agent. This difference is statistically significant (P = 0.03). All wound infections presented within 2 weeks of operation and were deep. Povidone-iodine, 1 per cent, adversely affects the wound infection rate in late appendicitis and should not be used.