BACKGROUND: Intra-abdominal adhesions remain a major clinical problem. Previously, rifamycin lavage was used to prevent adhesion formation in the septic abdomen. The aim of our study was to test the effectiveness of intraperitoneal application of alternate antibiotics in an abdominal sepsis model. METHODS: Sixty Wistar-albino rats were randomly divided into 6 equal groups. Bacterial peritonitis was induced using caecal ligation and puncture model in all groups. Group 1 was an untreated control. The peritoneum was lavaged with isotonic saline in Group 2, with imipenem in Group 3, with ceftriaxone in Group 4, with cefazolin in group 5 and with metronidazole in group 6. Four weeks after the surgery, intra-abdominal adhesions were graded, tensile strength of the adhesions was measured and histopathological examinations were performed. RESULTS: Imipenem, ceftriaxone and cefazolin significantly reduced adhesion formation (p<0.001) with significantly reduced fibrosis scores (p=0.013). Adhesion formation was greatest in the metronidazole treatment group. The breaking force of adhesions was significantly reduced in Groups 4 and 5 (p<0.001). Although, the inflammation scores were similar between groups (p=0.058), grade 3 inflammation scores were only seen in control, saline and metronidazole-treatment groups. CONCLUSION: According to these data, cephalosporins may be effective in preventing adhesion formation in septic abdomens. These antibiotics need to be evaluated in a clinical trial.
BACKGROUND: Intra-abdominal adhesions remain a major clinical problem. Previously, rifamycin lavage was used to prevent adhesion formation in the septic abdomen. The aim of our study was to test the effectiveness of intraperitoneal application of alternate antibiotics in an abdominal sepsis model. METHODS: Sixty Wistar-albino rats were randomly divided into 6 equal groups. Bacterial peritonitis was induced using caecal ligation and puncture model in all groups. Group 1 was an untreated control. The peritoneum was lavaged with isotonic saline in Group 2, with imipenem in Group 3, with ceftriaxone in Group 4, with cefazolin in group 5 and with metronidazole in group 6. Four weeks after the surgery, intra-abdominal adhesions were graded, tensile strength of the adhesions was measured and histopathological examinations were performed. RESULTS:Imipenem, ceftriaxone and cefazolin significantly reduced adhesion formation (p<0.001) with significantly reduced fibrosis scores (p=0.013). Adhesion formation was greatest in the metronidazole treatment group. The breaking force of adhesions was significantly reduced in Groups 4 and 5 (p<0.001). Although, the inflammation scores were similar between groups (p=0.058), grade 3 inflammation scores were only seen in control, saline and metronidazole-treatment groups. CONCLUSION: According to these data, cephalosporins may be effective in preventing adhesion formation in septic abdomens. These antibiotics need to be evaluated in a clinical trial.
Authors: Richard P G Ten Broek; Pepijn Krielen; Salomone Di Saverio; Federico Coccolini; Walter L Biffl; Luca Ansaloni; George C Velmahos; Massimo Sartelli; Gustavo P Fraga; Michael D Kelly; Frederick A Moore; Andrew B Peitzman; Ari Leppaniemi; Ernest E Moore; Johannes Jeekel; Yoram Kluger; Michael Sugrue; Zsolt J Balogh; Cino Bendinelli; Ian Civil; Raul Coimbra; Mark De Moya; Paula Ferrada; Kenji Inaba; Rao Ivatury; Rifat Latifi; Jeffry L Kashuk; Andrew W Kirkpatrick; Ron Maier; Sandro Rizoli; Boris Sakakushev; Thomas Scalea; Kjetil Søreide; Dieter Weber; Imtiaz Wani; Fikri M Abu-Zidan; Nicola De'Angelis; Frank Piscioneri; Joseph M Galante; Fausto Catena; Harry van Goor Journal: World J Emerg Surg Date: 2018-06-19 Impact factor: 5.469