Surgical site infections (SSIs) remain widespread in spite of development in surgical techniques and preventive measures. As such, treatment methods continue to be evaluated to find promising solutions. One such method involves the use of topical antibiotics such as gentamicin. This article delves into a recent randomized controlled trial aiming to assess the effectiveness of topical gentamicin in preventing SSIs in patients undergoing incisional hernia repair with mesh.
The trial separated participants into two groups – the gentamicin group and the saline solution group. During the surgical procedure, each layer of the abdominal wall was irrigated either with a gentamicin solution or a normal saline solution, depending on the group they were assigned to. Subsequent comparison of SSIs and other surgical site complications between these groups formed the basis of this study.
Data from 146 patients were included, with 74 in the gentamicin group and 72 in the saline solution group. Within these subgroups, SSIs occurrence was recorded in 8.1% and 11.1% of cases respectively, a disparity that was not statistically significant. Other surgical site issues such as seroma (a pocket of clear serous fluid at the surgical site), hematoma (accumulation of blood clots), and surgical wound dehiscence (separation of surgical incision edges) revealed no notable differences between the groups. Crucially, there were no adverse effects recorded from the topical application of gentamicin.
Despite these findings, the trial concluded that the application of topical gentamicin in incisional hernia repair with mesh didn’t significantly decrease the incidence of SSIs. Tracing back to similar studies and professional guidelines, there is an existent contention about the use of topical antibiotics. For instance, the World Health Organization (WHO) and Center for Disease Control and Prevention (CDC) do not recommend the use of topical antibiotics pre-wound closure due to inconsistent evidence on their effectiveness, although exceptions exist for certain procedures and populations. Overall, the need for high-quality data to support the use of topical antibiotics in preventing SSIs is prominent.
In the end, these findings highlight the need for further clinical trials that can enhance the understanding and effective use of topical antibiotics in preventing SSIs.