Subcutaneous irrigation with rifampicin <i>vs.</i> povidone-iodine for the prevention of incisional surgical site infections following caesarean section: a prospective, randomised, controlled trial

The aim is to investigate the effect of irrigation of subcutaneous tissue with saline, rifampicin, or povidone-iodine on incisional surgical site infections following caesarean section. Three hundred patients scheduled for caesarean section were randomly assigned into one of three groups of 100 members each, as follows: the subcutaneous tissue was irrigated with saline in group 1 (control); saline + rifampicin in group 2; saline + 10% povidone-iodine in group 3. Patients who developed a superficial incisional surgical site infection within 30 days were recorded. The surgical site infection rate did not differ when using rifampicin or povidone-iodine (p = .202). It was observed that there was a statistically significant increase in the rate of incisional surgical site infections as the existence of comorbidities (p = .001), perioperative blood transfusion (p = .020), and midline incision (p = .004). Irrigation of subcutaneous tissue with rifampicin or 10% povidone-iodine is not effective in preventing surgical site infections after caesarean section.IMPACT STATEMENTWhat is already known on this subject? An increase has recently been observed in the incidence of SSI particularly in caesarean sections due to reasons, such as that elderly mothers are more commonly operated on compared to the past and long and complicated operations (Lachiewicz et al. 2015 Lachiewicz MP, Moulton LJ, Jaiyeoba O. 2015. Pelvic surgical site infections in gynecologic surgery. Infectious Diseases in Obstetrics and Gynecology 2015:614950.[Crossref], [PubMed] , [Google Scholar]) and there are no clear decisions on measures to be taken. Also, there are not many studies on this subject (De Nardo et al. 2016 De Nardo P, Gentilotti E, Nguhuni B, Vairo F, Chaula Z, Nicastri E, et al. 2016. Post-caesarean section surgical site infections at a Tanzanian tertiary hospital: a prospective observational study. The Journal of Hospital Infection 93:355–359.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]; Solomkin et al. 2017 Solomkin JS, Mazuski J, Blanchard JC, Itani KM, Ricks P, Dellinger EP, et al. 2017. Introduction to the centers for disease control and prevention and the healthcare infection control practices advisory committee guideline for the prevention of surgical site infections. Surgical Infections 18:385–393.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]).What do the results of this study add? In our study, we investigated the effectiveness of subcutaneous agents that have been used by many surgeons for years and we've revealed that it's not effective. There is no study in the literature comparing 3 different irrigation agents as we did in our study. For this reason, we think that we will make an important contribution to the measures to be taken in this important issue.What are the implications of these findings for clinical practice and/or further research? This study may contribute to reaching a sufficient level of evidence on surgical wound infections after caesarean sections, which are still missing in the literature, and that may be guiding for the studies that will be conducted on this subject in the future.