Topical antibiotic and delayed primary closure in the management of contaminated surgical incisions

In a randomized study of abdominal incisions contaminated by bacteria from acute appendicitis and perforative trauma to the gastrointestinal tract, delayed primary closure of the skin and subcutaneous layers significantly reduced the incidence of subsequent wound infection. However, the open wound that had been prepared for later closure frequently became colonized by hospital pathogens and subsequently became infected after closure by a different set of bacteria. An antibiotic aerosol spray (Neosporin) of the contaminated surgical incision just prior to primary wound closure also significantly reduced the incidence of wound infection. Failures were noted to occur when the contaminating bacteria were relatively resistant to the topically administered antibiotic. Intravenously administered cephalothin (Keflin) failed to diminish the wound infection rate in contaminated surgical incisions, irrespective of whether the systemic antibiotic was administered preoperatively or post operatively.