Skip to main content

Advertisement

SpringerLink
Log in

Antimicrobial prophylaxis in appendectomy patients

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Infection commonly follows removal of the gangrenous or perforated appendix. However, if the appendix is normal or simply acutely inflamed, the rate of infection is low. The organisms most frequently isolated from the wound after appendectomy are Bacteroides (especiallyB. fragilis) andEscherichia coli. A combination of chemoprophylaxis effective against these 2 groups of organisms is the most rational choice of antimicrobial cover. Such antimicrobial cover should be given to all patients with a gangrenous or perforated appendix and to all other patients with appendicitis who have compromised immune systems. Prophylaxis is probably unnecessary in patients with a normal immune system who present with uncomplicated appendicitis.

Résumé

Les risques d'infection sont élevés après appendicectomie pour appendicite perforée et gangrène appendiculaire alors qu'il sont réduits après appendicectomie pour appendicite aiguë banale. Les germes le plus souvent en cause sont les bactéroïdes et les escherichia coli. Pour prévenir l'infection due à ces deux organismes il est indiqué d'administrer préventivement deux au moins des agents antimicrobiens spécifiques. Cette antibiothérapie spécifique préventive n'est pas indispensable chez les sujets dont le système immunitaire est normal ou qui présentent une appendicite aiguë banale.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Leading article: Lancet1:930, 1979

  2. Leading article: Lancet2:195, 1971

  3. Leigh, D.A., Simmonds, K., Norman, E.: Bacterial flora of the appendix fossa in appendicitis and postoperative wound infection. J. Clin. Pathol.27:997, 1974

    Google Scholar 

  4. Lari, J., Kirk, D., Howden, R.: Bacteriological survey of acute appendicitis in children. Br. J. Surg.63:643, 1976

    Google Scholar 

  5. Leigh, D.A., Pease, R., Henderson, H., Simmons, K., Russ, R.: Prophylactic lincomycin in the prevention of wound infection following appendicectomy: A double blind study. Br. J. Surg.63:973, 1976

    Google Scholar 

  6. Willis, A.T., Ferguson, I.R., Jones, P.H., Phillips, K.D., Tearle, P.V., Berry, R.B., Fiddian, R.V., Graham, D.F., Harland, D.H.C., Innes, D.B., Mee, W.M., Rothwell-Jackson, R.L., Sutch, I., Kilbey, C., Edwards, D.: Metronidazole in prevention and treatment of bacteroides infections after appendicectomy. Br. Med. J.1:318, 1976

    Google Scholar 

  7. Marchildon, M.B., Dudgeon, D.L.: Perforated appendicitis. Current experience in a children's hospital. Ann. Surg.185:84, 1977

    Google Scholar 

  8. Leigh, D.A.: Indications for antibiotic prophylaxis and treatment in patients undergoing appendicectomy. J. Antimicrob. Chemother.4(Suppl. C):15, 1978

    Google Scholar 

  9. Greenall, M.J., Bakran, A., Pickford, F.R., Bradley, J.A., Halsall, A., Macfie, J., Odell, M., Cooke, E.M., Lincoln, C., McMahon, M.J.: A double-blind trial of a single intravenous dose of metronidazole as prophylaxis against wound infection following appendicectomy. Br. J. Surg.66:428, 1979

    Google Scholar 

  10. Pinto, D.J.P., Sanderson, J.: Rational use of antibiotic therapy after appendicectomy. Br. Med. J.1:275, 1980

    Google Scholar 

  11. Gottrup, F.: Prophylactic metronidazole in prevention of infection after appendicectomy: Report of a double-blind trial. Acta Chir. Scand.146:133, 1980

    Google Scholar 

  12. Pashby, N., Mee, W.M.: Metronidazole prophylaxis and primary wound closure in appendicectomy. J. Antimicrob. Chemother.4(Suppl. C):25, 1978

    Google Scholar 

  13. Donovan, I.A., Ellis, D., Gatehouse, D., Little, G., Grimley, R., Armistead, S., Keighley, M.R.B., Strachan, C.S.L.: One-dose antibiotic prophylaxis against wound infection after appendicectomy: A randomised trial of clindamycin, cefazoline sodium and a placebo. Br. J. Surg.66:193, 1979

    Google Scholar 

  14. Rodgers, J., Ross, D., McNaught, W., Gillespie, G.: Intrarectal metronidazole in the prevention of anaerobic infection after emergency appendicectomy: A controlled clinical trial. Br. J. Surg.66:425, 1979

    Google Scholar 

  15. Fine, M., Busuttil, R.W.: Acute appendicitis: Efficacy of prophylactic pre-operative antibiotics in the reduction of septic morbidity. Am. J. Surg.135:210, 1978

    Google Scholar 

  16. Gottrup, F., Sakso, P.: Metronidazole and appendici-tis. Can a preoperative prophylaxis be changed to a peroperative treatment in high risk patients 2: Acta Chir. Scand.147:445, 1981

    Google Scholar 

  17. Berger, S.A., Nagar, H., Weitzman, S.: Prophylactic antibiotics in surgical procedures. Surg. Gynecol. Obstet.146:469, 1978

    Google Scholar 

  18. Lungquist, U.: Wound sepsis after clean operations. Lancet1:1095, 1964

    Google Scholar 

  19. National Academy of Sciences-National Research Council, Division of Medical Sciences, Ad Hoc Committee of the Committee on Trauma: Postoperative wound infections: The influence of ultraviolet irradiation of the operating room and of various other factors. Ann. Surg.160(Suppl. 2):1, 1964

    Google Scholar 

  20. Keighley, M.R.B.: Prevention of wound sepsis in gastro-intestinal surgery. Br. J. Surg.64:315, 1977

    Google Scholar 

  21. Andersen, B., Bendtsen, A., Holbraad, L., Schantz, A.: Wound infections after appendicectomy. Acta Chir. Scand.138:531, 1972

    Google Scholar 

  22. Barnes, B.A., Behringer, G.E., Wheetlock, F.C., Wilkins, E.W.: Surgical sepsis: Analyses of factors associated with sepsis following appendectomy (1937–1959). Ann. Surg.156:703, 1962

    Google Scholar 

  23. Bird, G.G., Bunch, G.A., Croft, C.B., Hoffmann, D.C., Humphrey, C.S., Rhind, J.R., Rosenberg, I.L., Whittaker, M., Whittaker, A.R., Hall, R.: Topical nyxythiolin antisepsis. Report of a controlled trial. Br. J. Surg.58:447, 1971

    Google Scholar 

  24. Gilmore, O.J.A., Martin, T.D.M., Fletcher, B.N.: Prevention of wound infection after appendicectomy. Lancet1:220, 1973

    Google Scholar 

  25. Bates, T., Down, R.H.L., Haughton, M.C.V., Lloyd, G.J.: Topical ampenicillin in the prevention of wound infection after appendicectomy. Br. J. Surg.61:489, 1974

    Google Scholar 

  26. Gilmore, O.J.A., Martin, J.D.M.: Aetiology and prevention of wound infection in appendicectomy. Br. J. Surg.61:281, 1974

    Google Scholar 

  27. Nyström, P.-O., Bröte, L.: Effects of a plastic wound drape on contamination with enterobacteria and on infection after appendicectomy. Acta Chir. Scand.146:65, 1980

    Google Scholar 

  28. Renvall, S., Niinikoski, J., Aho, A.J.: Wound infection in abdominal surgery. A prospective study of 696 operations. Acta Chir. Scand.146:25, 1980

    Google Scholar 

  29. Gjengedal, E.: Akutt perforert appendicitt. Et 5 ars materiale. Tidsskr. Nor. Lageforen.98:770, 1978

    Google Scholar 

  30. Grosfeld, J.L., Solit, R.W.: Prevention of wound infection in perforated appendicitis. Experience with delayed primary wound closure. Ann. Surg.168:891, 1968

    Google Scholar 

  31. Stone, H.H., Hopper, C.A., Millikan, W.J.: Abdominal drainage following appendectomy and cholecystectomy. Ann. Surg.187:606, 1978

    Google Scholar 

  32. Gorbach, S.L., Bartlett, J.G.: Anaerobic infections. (First of three parts.) N. Engl. J. Med.290:1177, 1974

    Google Scholar 

  33. Nichols, R.L., Miller, B., Smith, J., Schumer, W.: Anaerobic infections following abdominal surgery. Clin. Med.81:23, 1974

    Google Scholar 

  34. Stone, H.H., Kolb, L.D., Geheber, C.E.: Incidence and significance of intraperitoneal anaerobic bacteria. Ann. Surg.181:705, 1975

    Google Scholar 

  35. Pollock, A.V.: Surgical wound sepsis. Lancet1:1283, 1979

    Google Scholar 

  36. Polk, H.C.: Operating room acquired infection: A review of pathogenesis. Am. Surg.45:349, 1979

    Google Scholar 

  37. Condon, R.E.: Rational use of prophylactic antibiotics in gastrointestinal surgery. Surg. Clin. North Am.55:1309, 1975

    Google Scholar 

  38. Burke, J.F.: Infection. In Fundamentals of Wound Management, T.K. Hunt, J.E. Dunphy, editors, New York, Appleton-Century-Crofts, 1979, pp. 170–240

    Google Scholar 

  39. Burke, J.F.: The effective period of preventing antibiotic in experimental incisions and dermal lesions. Surgery50:161, 1961

    Google Scholar 

  40. Everson, N.W., Fossard, D.P., Nash, J.R., MacDonald, R.C.: Wound infection following appendicectomy: The effect of extra-peritoneal wound drainage and systemic antibiotic prophylaxis. Br. J. Surg.64:236, 1977

    Google Scholar 

  41. Thadepalli, H.: Principles and practice of antibiotic therapy for post traumatic abdominal injuries. Surg. Gynecol. Obstet.148:937, 1979

    Google Scholar 

  42. Thanphiphat, C., Sangsubhan, C., Vongvaravipatr, V., La-Ongthong, B., Chodchoy, V., Treesaranuvatana, S., Ittipong, P.: Wound infection in emergency appendicectomy: A prospective trial with topical ampenicillin and antiseptic solution irrigation. Br. J. Surg.65:89, 1978

    Google Scholar 

  43. Viljanto, J.: Disinfection of surgical wounds without inhibition of normal wound healing. Arch. Surg.115:253, 1980

    Google Scholar 

  44. Rickett, J.W.S., Jackson, B.T.: Topical ampencillin in the appendicectomy wound: A report of a doubleblind trial. Br. Med. J.4:206, 1969

    Google Scholar 

  45. Mountain, J.C., Seal, P.V.: Topical ampenicillin in grid-iron appendicectomy wounds. Br. J. Clin. Pract.24:111, 1970

    Google Scholar 

  46. Nambier, R., Ngiru, R.C.K.: A randomised comparative study of metronidazole and gentamicin in suppurative and perforated appendicitis. Presented to S.E. Asian Congress of Surgeons, 1981 (in press)

Download references

Author information

Authors and Affiliations

  1. University Department of Surgical Gastroenterology, Aarhus County Hospital, Aarhus, Denmark

    Finn Gottrup M.D. & Thomas K. Hunt M.D.

  2. Department of Surgery, University of California, San Francisco, California, USA

    Finn Gottrup M.D. & Thomas K. Hunt M.D.

Authors
  1. Finn Gottrup M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas K. Hunt M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gottrup, F., Hunt, T.K. Antimicrobial prophylaxis in appendectomy patients. World J. Surg. 6, 306–311 (1982). https://doi.org/10.1007/BF01653546

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01653546

Keywords

Search

Navigation