Efficacy of antisepsis and prophylactic administration of cefazolin in preventing contamination of the operating field in clean orthopaedical surgery
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2025
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O principal objetivo deste estudo foi avaliar se a realização de antissepsia com uma solução de clorexidina a 2% e álcool isopropílico a 70%, assim como a administração profilática de cefazolina (22mg/kg, IV), seriam eficazes na prevenção da contaminação do campo cirúrgico durante a cirurgia ortopédica limpa. Na realização deste estudo, foram recolhidas zaragatoas fecais e de pele de 63 animais submetidos a cirurgia ortopédica limpa, antes do protocolo de antissepsia e administração profilática de cefazolina. Adicionalmente, em todos os animais, após a realização da antissepsia e administração profilática de cefazolina foram também recolhidas zaragatoas da pele e do campo cirúrgico em vários momentos da cirurgia e de acordo com a duração da mesma: período de incisão (T0min), a 45 minutos de cirurgia (T45min), entre 45 a 90 minutos de cirurgia (T>45-90min) e após 90 minutos de cirurgia (T>90min). Todo o material recolhido foi inoculado e avaliado de forma a ser possível determinar a presença ou ausência de crescimento bacteriano, incluindo enterobactérias resistentes a cefalosporinas de 3º geração e carbapenemos, assim como Staphylococcus spp. resistentes à meticilina. O teste de Wilcoxon foi utilizado para comparar as diferenças entre a contaminação da pele antes e depois do protocolo de antissepsia. A comparação entre a contaminação e duração da cirurgia foi analisada com base no teste de Kruskal-Wallis. Os resultados do estudo permitiram observar uma redução significativa do crescimento bacteriano na pele após a realização do protocolo de antissepsia e da administração de cefazolina (p (p <0.001). A contaminação intraoperatória apresentou diferenças significativas entre os tempos cirúrgicos (p = 0.024). Os resultados sugerem também que um protocolo de antissepsia com clorexidina a 2%e álcool isopropílico a 70%, juntamente com a administração profilática de cefazolina (22mg/kg, IV) são eficazes na prevenção da contaminação do campo cirúrgico em cirurgia ortopédica limpa por bactérias Gram-positivas. No entanto, não são eficazes na prevenção da contaminação por bactérias Gram-negativas. O estudo também indica que a escolha e o uso de antimicrobianos pós-cirúrgicos devem ser baseados nos resultados de culturas bacterianas positivas e nos testes de suscetibilidade, realizados com o material colhido antes do encerramento da ferida cirúrgica.
The main objective of this study was to evaluate whether performing antisepsis with a solution of 2% chlorhexidine and 70% isopropyl alcohol and prophylactic administration of cefazolin (22mg/kg, IV) are effective in preventing contamination of the surgical field during clean orthopedic surgery. In this study, fecal and skin swabs were collected from 63 animals submitted to clean orthopedic surgery, before the antisepsis protocol and prophylactic administration of cefazolin. In addition, in all animals, after antisepsis and prophylactic administration of cefazolin, swabs were also collected from the skin and the surgical field at various times of the surgery and according to the duration of the surgery: incision period (T0min), 45 minutes after surgery (T45min), between 45 and 90 minutes after surgery (T>45-90min) and after 90 minutes of surgery (T>90min). All collected material was inoculated and evaluated to determine the presence or absence of bacterial growth, including enterobacteria resistant to 3rd generation cephalosporins and methicillin-resistant carbapenems and Staphylococcus spp. The Wilcoxon test was used to compare the differences between skin contamination before and after the antisepsis protocol. The comparison between contamination and duration of surgery was analyzed based on the Kruskal-Wallis test. The results of the study showed a significant reduction in bacterial growth on the skin after the antisepsis protocol and cefazolin administration (p <0.001). Intraoperative contamination showed significant differences between surgical times (p = 0.024). The results also suggest that an antisepsis protocol with 2% chlorhexidine and 70% isopropyl alcohol, together with the prophylactic administration of cefazolin (22mg/kg, IV) are effective in preventing contamination of the surgical field in clean orthopedic surgery by Gram-positive bacteria. However, they fail to prevent contamination by Gram-negative bacteria. The study also suggests that the use and selection of post-surgical antimicrobials should be based on the results of positive bacterial cultures and susceptibility tests of material collected before surgical wound closure.
The main objective of this study was to evaluate whether performing antisepsis with a solution of 2% chlorhexidine and 70% isopropyl alcohol and prophylactic administration of cefazolin (22mg/kg, IV) are effective in preventing contamination of the surgical field during clean orthopedic surgery. In this study, fecal and skin swabs were collected from 63 animals submitted to clean orthopedic surgery, before the antisepsis protocol and prophylactic administration of cefazolin. In addition, in all animals, after antisepsis and prophylactic administration of cefazolin, swabs were also collected from the skin and the surgical field at various times of the surgery and according to the duration of the surgery: incision period (T0min), 45 minutes after surgery (T45min), between 45 and 90 minutes after surgery (T>45-90min) and after 90 minutes of surgery (T>90min). All collected material was inoculated and evaluated to determine the presence or absence of bacterial growth, including enterobacteria resistant to 3rd generation cephalosporins and methicillin-resistant carbapenems and Staphylococcus spp. The Wilcoxon test was used to compare the differences between skin contamination before and after the antisepsis protocol. The comparison between contamination and duration of surgery was analyzed based on the Kruskal-Wallis test. The results of the study showed a significant reduction in bacterial growth on the skin after the antisepsis protocol and cefazolin administration (p <0.001). Intraoperative contamination showed significant differences between surgical times (p = 0.024). The results also suggest that an antisepsis protocol with 2% chlorhexidine and 70% isopropyl alcohol, together with the prophylactic administration of cefazolin (22mg/kg, IV) are effective in preventing contamination of the surgical field in clean orthopedic surgery by Gram-positive bacteria. However, they fail to prevent contamination by Gram-negative bacteria. The study also suggests that the use and selection of post-surgical antimicrobials should be based on the results of positive bacterial cultures and susceptibility tests of material collected before surgical wound closure.
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VETERINARY MEDICINE, VETERINARY SURGERY, VETERINARY ORTHOPEDICS, BACTERIAL CONTAMINATION, ANTIMICROBIAL, ANTISEPSIS, PROPHYLAXIS, INFECTION CONTROL, PUBLIC HEALTH, MESTRADO INTEGRADO EM MEDICINA VETERINÁRIA, VETERINÁRIA, MEDICINA VETERINÁRIA, CIRURGIA VETERINÁRIA, ORTOPEDIA VETERINÁRIA, CONTAMINAÇÃO BACTERIANA, ANTIMICROBIANOS, ANTISSÉPSIA, PROFILAXIA, CONTROLO DE INFEÇÕES, SAÚDE PÚBLICA, RESISTÊNCIA AOS MEDICAMENTOS, RESISTÊNCIA AOS ANTIBIÓTICOS