title: Irrigation of abdomen with imipenem solution decreases surgical site infections in patients with perforated appendicitis: a randomized clinical trial.
abstract: BACKGROUND
  Perforated appendicitis is one of the most common causes of acute abdomen requiring emergent surgery for immediate appendectomy and peritoneal cavity irrigation; however, the efficacy of irrigation with antibiotic solutions is controversial.
  
  
  OBJECTIVE
  The aim of this study was to assess the efficacy of imipenem solution irrigation on post-operative surgical site infections (SSIs), hospital length of stay, and hospital costs. We hypothesized that there would be lower rate of SSIs, a shorter hospital stay, and lower hospital cost in patients with perforated appendicitis who received peritoneal cavity irrigation with imipenem solution in comparison to their counterparts who received irrigation with normal saline.
  
  
  METHODS
  In this randomized single-blind parallel-group clinical trial, we enrolled 90 patients with perforated appendicitis with 12-50 years of age and randomly allocated them into experimental group (n = 45) and control group (n = 45). The control group received peritoneal irrigation with normal saline (0.9%) and experimental group underwent peritoneal irrigation with imipenem solution (1 mg/mL). All surgical procedures were performed in Imam Reza Hospital of Kermanshah University of Medical Sciences. The study primary outcome was surgical site infections (including wound infection and abdominal abscess) and the secondary outcomes were length of hospital stay and hospital cost. Chi-squared and t-tests were used to analyze the study data.
  
  
  RESULTS
  Imipenem solution irrigation was associated with significant clinical improvement at one-month follow-up. The experimental group presented with significantly lower rate of SSIs and shorter length of hospital stay. The experimental group had lower rate of SSIs compared to the control group (4.4% vs. 22.2%, respectively) (p= 0.013). The duration of hospital stay was nearly one day longer in control group (5.84 ± 2.58 days) vs. experimental group (4.91 ± 1.29 days) (P = 0.034), and hospital costs were $50 lower in experimental group ($500 ± $292) vs. control group ($450 ± $170) (P = 0.281).
  
  
  CONCLUSIONS
  The study findings revealed that peritoneal lavage with imipenem solution (1 mg/mL) decreases the rate of post-operative SSIs in patients with perforated appendicitis in comparison to patients irrigated with normal saline alone. These patients also had shorter hospital stay, and lower hospital costs.
authors.affiliation: Department of Surgery, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran.
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Hesami
authors.affiliation: Department of Surgery, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Alipour
authors.affiliation: Department of Surgery, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran.
authors.forename: Hamed
authors.initials: H
authors.lastname: Nikoupour Daylami
authors.affiliation: Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Bijan
authors.initials: B
authors.lastname: Alipour
authors.affiliation: Department of Psychiatry, Charles R. Drew University of Medicine and Sciences, and David Geffen School of Medicine, UCLA, USA.
authors.forename: Shahrzad
authors.initials: S
authors.lastname: Bazargan-Hejazi
authors.affiliation: Department of Public Health Sciences, Division of Social Medicine, Karolinska Institute, Stockholm, Sweden ; Department of Anesthesiology, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Ahmadi
keywords: Abdominal Abscess; Appendicitis; Iran; Peritoneal Lavage; Surgical Site Infection; Wound Infection