Zhadan Olga, Becker Hilton
Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL.
Aesthet Surg J. 2018 Feb 15;38(3):265-273. doi: 10.1093/asj/sjx171.
BACKGROUND: The incidence of infection following breast implant reconstruction remains high at the level of 24%. Surgical site irrigation is commonly used for its prevention. However, the lack of evidence-based guidelines for antibiotic prophylaxis in breast implant surgery necessitates research for optimal irrigation technique. OBJECTIVES: composition and exposure time of irrigation solution for surgical site infection (SSI) prophylaxis using an in vitro model of a surgical site. METHODS: The study design was an in vitro model to assess antibiotic irrigation of a surgical site. Strains of Staphylococcus aureus, Methicillin-resistant Staphylococcus aureus, Group A Streptococcus, and Pseudomonas aeruginosa were seeded on blood agar growth medium and irrigated with various antibiotic and antiseptic solutions under different exposure times. The presence and quantity of the colonies grown were estimated after 24-hour incubation. Repetition of the studies for 5 times with each investigated irrigation solution and microorganism was performed. Optimal irrigation agents were chosen based on the ability to achieve sterility with minimal tissue toxicity. RESULTS: The optimal wound irrigation agents for SSI prophylaxis in our study were found to be 0.05% chlorhexidine or triple antibiotic antibiotic solutions. Adding of vancomycin to the irrigation solutions did not show an increase in their effectiveness. Prolonged irrigation exposure time was necessary to achieve sterility of the in vitro model of a surgical site. CONCLUSIONS: We recommend 0.05% chlorhexidine or triple antibiotic solution for topical SSI prophylaxis in breast implant surgery. Sufficient time of irrigation can be achieved by maintaining some of the solution in the pocket and delaying drainage for at least 30 minutes.
背景:乳房植入物重建术后感染发生率仍高达24%。手术部位冲洗常用于预防感染。然而,乳房植入手术中缺乏基于证据的抗生素预防指南,因此有必要研究最佳冲洗技术。 目的:使用手术部位体外模型确定用于预防手术部位感染(SSI)的冲洗液成分和暴露时间。 方法:本研究设计为评估手术部位抗生素冲洗的体外模型。将金黄色葡萄球菌、耐甲氧西林金黄色葡萄球菌、A组链球菌和铜绿假单胞菌菌株接种在血琼脂生长培养基上,并在不同暴露时间下用各种抗生素和防腐剂溶液冲洗。孵育24小时后估计生长菌落的存在和数量。对每种研究的冲洗液和微生物重复进行5次研究。根据以最小组织毒性实现无菌的能力选择最佳冲洗剂。 结果:在我们的研究中,发现用于预防SSI的最佳伤口冲洗剂是0.05%氯己定或三联抗生素溶液。在冲洗液中添加万古霉素并未显示其有效性增加。延长冲洗暴露时间对于实现手术部位体外模型的无菌是必要的。 结论:我们推荐在乳房植入手术中使用0.05%氯己定或三联抗生素溶液进行局部SSI预防。通过在腔隙中保留一些溶液并延迟引流至少30分钟,可以实现足够的冲洗时间。
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