Various strategies have been used to try limiting at the utmost post-operative infections (use of antibiotics before the intervention with different timings, keeping of normal body temperature, hair cutting and then shaving), but some problems still remain to be discussed, like the choice of the best skin antisepsis or the decision to sterilize the carriers of nasal Staphylococcus Aureus. Now, two new trials are trying to solve this problem. Some researchers in the USA have randomized 897 adults destined to surgeries to a preparation of skin through chlorhexidine gluconate (Hibiscrub ©) or through povidone-iodine (Betadine ©), evaluating the frequency of post-operative infections in the following 30 days. Through intent-to-treat analyses, the use of Hibiscrub has implied a lower rate of overall infections (9.5% vs. 16.1%; P=0.004), both superficial (4.2% vs. 8.6%; P=0.008) and localized deep ones (1.0% vs. 3.0%; P=0.05). There has been no statistically significant difference, instead, as to sepsis. In Holland, instead, 6771 patients have undergone PCR test searching carriers of nasal Staphylococcus. 1251 of them resulted positive and, out of these, 918 have been randomized to receive, for five days, a treatment of two daily endonasal administrations of mupirocin at 2% (Bactroban ©) plus a daily washing with Hibiscrub © or placebo. The rate of infections associated with Staphylococcus infections has been significantly lower in the treated group (3.4% vs. 7.7%; RR 0.42; 95% CI 0.23-0.75). Most enrolled patients were surgical patients (88.1%) and most Staphylococcus infections were localized in the point of the surgical cut (81.6%). The rate of deep infections was itself lower in patients treated with mupirocin (0.9% vs. 4.4%; RR 0.21; 95% CI 0.07-0.62).
According to the US trial, Hibiscrub © should replace Betadine © in pre-operative skin prophylaxis, while we cannot understand, from the Dutch trial, which local treatment is really indicated for staphylococcus sterilization (whether Hibiscrub © or Bactroban ©). It still remains to establish whether it is more convenient to perform a screening and then a following targeted treatment or to adopt a complete washing of surgical patients with medicated soap.
