Topical Metronidazole To Prevent Surgical Site Infection In Emergency Exploratory Laparotomy For Gastrointestinal Perforation.

Abstract

Background: Surgical Site Infection is one of the most common postoperative complications in exploratory laparotomy performed for gastrointestinal perforations. It increases the morbidity and prolongs total hospital stay, thus increasing the cost of treatment, in spite of following aseptic techniques in many cases. Hence, it is necessary to find out effective solutions to minimize the same. Metronidazole is a commonly used antibiotic which is effective against anaerobic organisms. Topical use of metronidazole in treating various skin infections and wounds is well established. In this study we used metronidazole solution lavage to surgical site and therefore is estimated to prevent surgical site infection as well.

Methods:36 Participants were divided into cases and controls. After closure of rectus sheath, cases received metronidazole wound wash whereas controls received normal saline wound wash. All patients were checked for Surgical Site Infection at regular intervals. Asepsis score was used to divide them into groups who did not have any surgical site infection and those who had. The latter were further divided into minor, moderate and major surgical site infection bases on Asepsis score only.

Results:4 out of 18 patients from cases developed surgical site infection and 9 out of 18 patients from controls developed surgical site infection (p=0.07). However, presence of major Surgical Site Infection was found in 6 patients in the control group and only in 1 patient in the cases group (p=0.035), which is statistically significant.

Conclusions:Use of metronidazole solution lavage to surgical site significantly reduces major surgical site infection. Overall results show that the number of patients who developed surgical site infection is less in the cases group.