[Prospective study on the prevention of wound infections after appendectomy for acute appendicitis]

In the search for an appropriate antibiotic to reduce the rate of postoperative wound infection in patients with acute appendicitis, we have randomized 150 patients preoperatively in a prospective 3-arm study. The operation technique was standardized for all patients and involved the use of plastic wound protectors. Bacterial contamination was documented by 3 swabs taken during operation. In 2 arms, patients received short-term adjuvant prophylaxis with either cefazolin or clindamycin/tobramycin. The third arm served as a control. Wound contamination ws proven in 33% of all cases but only 4% developed a real wound infection. The rate of infection was almost identical in all groups, without a statistically significant difference in the chi2 test. It is concluded that wound infection after appendectomy cannot be prevented by prophylactic use of antibiotics. Careful operation technique with local protective steps is quite sufficient. Antibiotics should therefore be reserved for special indications.