Antibiotic Solutions for Surgical Irrigation

Key Messages

• During surgery, wounds can be washed out, or irrigated, using antibiotic, antiseptic, or saline solutions to prevent infections; the evidence in this report found over 20 different antibiotic solutions used across trials.
• Most studies showed that antibiotic irrigation solutions were better or no different compared to using antiseptic, saline, or no irrigation; however, a small number of studies indicated otherwise. One study reported in a systematic review showed fewer infections and complications for antiseptic compared to a triple antibiotic solution, while another study included in the same systematic review found a higher percentage of implant loss when a triple antibiotic solution was compared to antiseptic; data were poorly reported in these studies.
• Bacitracin-specific evidence was found in 2 studies; 1 study reported in 1 systematic review showed a higher percentage of infection when bacitracin irrigation was compared to cefazolin and saline irrigation; however, this was not statistically significant. Another study showed no differences in infections requiring surgical intervention or in hospitalization when bacitracin irrigation was compared to no irrigation.
• One guideline recommends that wound irrigation and intracavity lavage should not be conducted during surgery, and that applying antibiotics before wound closure should only be done as part of a research trial.
• Due to the mixed findings across studies, high-quality research is needed to clarify the role of antibiotic irrigation during surgery. Because guideline recommendations about wound irrigation, specifically, are based on research published before 2008, updated guidelines to include research from more current studies are needed to reflect current practice.