Prevention of surgical site infections by an infusion of topical antibiotics in morbidly obese patients.

BACKGROUND: The reported incidence of surgical site infection after abdominal surgery in morbidly obese patients is high (about 15% in most studies), and this is associated with considerable disability and an increased economic burden. Topical antibiotics may reduce the incidence of serious infections. METHODS: Standard techniques for the prevention of surgical site infections were used along with the introduction of kanamycin into the subcutaneous space of morbidly obese patients at the time of closure and allowing it to dwell for 2 h. Eight hundred thirty-seven evaluable patients were followed for the development of site complications for at least six weeks postoperatively. RESULTS: One of the 65 patients with a revisional procedure had a primary deep incisional surgical site infection, as did one of the 772 patients with a primary operation. Secondary deep incisional surgical site infections occurred in four patients, two after spontaneous evacuation of a seroma, one from excessive superficial contamination, and one following separation of a nonhealing surgical site. Additionally, 21 patients had minor surgical site complications including incisional separation and stitch-related infections, which required no significant expenditure of resources. CONCLUSIONS: Prolonged contact (2 h) of topical kanamycin solution with the surgical site greatly reduces the incidence of primary infections in the deep subcutaneous space of laparotomy sites in morbidly obese patients.

Prevention of deep wound infection in morbidly obese patients by infusion of an antibiotic into the subcutaneous space at the time of wound closure.

BACKGROUND: Wound infections have been reported to occur in as many as 15% of wounds following the open procedure for gastric bypass in morbidly obese patients, resulting in significant disability, an increased health-care expenditure, and even death. METHODS: This study was performed to assess the potential for reduction of wound infection in patients undergoing open gastric bypass by using a multimodal application of measures including infusion of an antibiotic (kanamycin) into the wound after closure and allowing it to dwell for 2 hours. Follow-up was for a minimum of 6 weeks. RESULTS: Of 400 consecutive evaluable patients, none had a wound infection which started in the subcutaneous fat or fascia. One patient had a stitch abscess, two had superficial infections secondary to wound separation after suture removal, and one had infection after spontaneous evacuation of a seroma. CONCLUSION: Using an infusion of kanamycin into the wound and allowing it to dwell for a 2-hour period, along with other standard preventive measures, eliminated primary deep subcutaneous and fascial wound infections after open gastric bypass procedures.