Cochrane Summaries

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Prevention of infection with surgery for peripheral arterial reconstruction

Stewart A, Eyers PS, Earnshaw JJ
Published Online: 
10 November 2010

Reconstruction of an artery with prosthetic graft materials or vein may be necessary to treat poor circulation. Surgery is used to bypass a blockage in an artery or prevent rupturing (as with aneurysms). Graft or deep wound infections are a serious complication that can be limb threatening and often life threatening. Most infections appear to be caused by bacteria from the patient's skin entering the wound at the time of surgery. Resistant bacteria have increased in prevalence and measures to prevent infection are therefore, essential. These methods include hair removal, pre-operative skin cleanliness and painting with antiseptics, theatre antisepsis procedures, surgical techniques, use of antibiotics and post-operative wound management. The review authors made a thorough search of the literature and identified thirty-five randomised controlled trials for inclusion in this review. Prophylactic treatment with systemic antibiotics, commenced immediately pre-operatively, reduced the risk of wound infection and almost certainly early graft infection by between three-quarters and two-thirds (RR 0.25 and 0.31, respectively). These conclusions are based on 10 studies that randomised 1297 patients to receive either prophylactic antibiotic or placebo. Antibiotic prophylaxis for greater than 24 hours appeared to be without added benefit, from three studies.

Other interventions intended to reduce the risk of infection in arterial reconstruction, including suction groin-wound drainage or pre-operative bathing or shower regimen with antiseptic agents over unmedicated bathing, lack evidence of effectiveness. There was no evidence from two studies (857 patients) that impregnating Dacron grafts with the antibiotic rifampicin, reduced graft infections over a two year follow-up period.