- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04476212
Prophylaxis of Surgical Wound Infection With Topical Antibiotics
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Several Surgical site infection (SSI) prevention guidelines have been published over the last 10 years. Topical prophylaxis of the surgical wound with antibiotics or antiseptics is one of the most controversial measures proposed for SSI prevention. Two guidelines (British, Spanish Ministry of Health) explicitly recommend not irrigating surgical wounds with any product. The World Health Organization considers irrigation with antibiotics as an unresolved issue and, together with the Centers for Disease Control, recommends irrigation with a solution of povidone iodine. The other four guides do not mention the measure. In Catalonia, a SSI prevention bundle recommends wound irrigation with saline, with a low level of recommendation.
Therefore, topical prophylaxis with operational wound washings with different solutions has been poorly studied, evokes contradictory recommendations and is not included in the majority of clinical practice guidelines for SSI prevention.
However, there we detected a high level of use of wound irrigation at the end of an intervention in actual clinical practice. In a survey conducted by 2017 by our group and answered by 845 general surgeons of the Spanish Association of Surgeons, before closing the skin, most surgeons (80.6%) irrigate the subcutaneous layer of the wound, either with saline (51.2%), an antiseptic solution (23.8%) or an antibiotic solution (1.5%). Only 19.4% of respondents do not irrigate. In another survey in 2018, focused on colorectal surgeons of two Spanish associations, similar rates of irrigation with saline, antiseptic or antibiotic were used (55%, 28.9% and 2.2%, respectively) The hypothesis of the study is that topical prophylaxis of the surgical wound with irrigation with an antibiotic solution decreases the rate of postoperative infection in patients undergoing abdominal surgery with different levels of contamination.
The study will compare the efficacy of topical prophylaxis in the surgical wound with an irrigation with an antibiotic solution in the incidence of SSI in abdominal surgery.
It is a randomized, controlled, multicenter, blind study by observer and patient, with two parallel study groups, phase IV.
Design of studies The project includes several prospective comparative studies on the effect of irrigation of surgical wounds with an antibiotic solution on the incisional SSI rate in abdominal surgery. The studies share a unique methodology applied to various types of abdominal surgery with different expected SSI rates and different risk factors.
In the trials, the irrigation of the wound with 0.9% physiological serum will be compared with the irrigation with an active principle solution of a pharmaceutical specialty of proven efficacy by parenteral route, administered topically and dissolved in physiological serum.
Four studies on different types of operations are defined according to the risk of infection:
- Study 1. Complex abdominal wall surgery
- Study 2. Cesarean section
- Study 3. Colorectal elective surgery
- Study 4. Emergency abdominal surgery For each study two groups will be formed, the study group (irrigation with antibiotic solution) and the control group (irrigation with saline).
The project has received the Spanish Drug Agency authorization as a low intervention study, a grant from the Spanish Ministry of Health and the Ethics Committee authorization of the Hospital General of Granollers.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Josep Maria Badia, PhD
- Phone Number: 2571 (+34) 938 425 000
- Email: jmbadia@fhag.es
Study Contact Backup
- Name: Gemma Molist, PhD
- Phone Number: 2973 (+34) 938 425 000
- Email: recerca@fjah.es
Study Locations
-
-
Barcelona
-
Granollers, Barcelona, Spain, 08402
- Recruiting
- Fundació Privada Hospital Asil de Granollers
-
Contact:
- Josep Maria Badia, PhD
- Phone Number: 2571 (+34) 938 425 000
- Email: jmbadia@fhag.es
-
Contact:
- Gemma Molist, PhD
- Phone Number: 2973 (+34) 938 425 000
- Email: recerca@fhag.es
-
Principal Investigator:
- Josep Maria Badia, PhD
-
Sub-Investigator:
- Felipe Ojeda, PhD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patients admitted for elective abdominal wall surgery by open route
- Patients admitted for urgent or elective cesarean section
- Patients undergoing elective surgery of the colon or rectum for neoplastic pathology (open or laparoscopy)
- Patients undergoing emergency abdominal surgery (open or laparoscopy)
Exclusion Criteria:
- Patients under treatment with immunosuppressors, corticosteroids and patients on hemodialysis
- Patients with primary peritonitis and liver cirrhosis
- Patients with suspected allergy to the antibiotic used in the study
- Patients who have recently undergone open abdomen surgery (up to 30 days pre-intervention) or to which the wound can not be closed surgical according to the surgeon's criteria
- Patients with American Society of Anaesthesiology classification 5.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Intervention
In the experimental arm, the surgical wound will be irrigated using an antibiotic solution (amoxicillin-clavulanate) for topical prophylaxis
|
The surgical wound will be irrigated with an antibiotic solution, and then we will apply the same solution using gauze for two minutes on the wound
|
No Intervention: Control
In the control arm, the surgical wound will be irrigated with saline, which is our routine at present.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Surgical Site infection rate
Time Frame: 30 days
|
signs of infection at any level of surgical site
|
30 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Complications after surgery
Time Frame: 30 days
|
Any complication after surgery, evaluated by the Clavien-dindo classification
|
30 days
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Josep Maria Badia, PhD, Fundació Privada Hospital Asil de Granollers
- Principal Investigator: Felipe Ojeda, PhD, Fundació Privada Hospital Asil de Granollers
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 20171013
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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