Pre-operative bladder irrigation with 1% Povidone iodine in reducing open prostatectomy surgical site infection (SSI) at university teaching hospital, Lusaka

Abstract

Purpose: The aim of the study is to assess the effectiveness of using preoperative bladder irrigation with 1% povidone iodine in reducing post transvesical prostatectomy surgical site infections. Study design: This was a prospective randomized cohort study with blinding of patients and outcome adjudicator regarding group assignments.
Methodology: One hundred and thirty patients were recruited from the waiting list of Urology unit II in the department of surgery during the period between July 2011 to December 2012. The non-probability convenience sampling technique was used. Any consenting patient who presented to the department of surgery for open prostatectomy and fulfills the inclusion criteria was selected. The patients were randomly allocated to each of the two groups. Each group had 65 patients. Patients in the study group had their bladder irrigated with 1% 50cc povidoneiodine which was drained upon opening the bladder followed by enucleating the adenomatous prostate gland. Hemostasis was ensured and a 3 way Foley's catheter inserted via the urethral into the bladder and ballooned appropriately for draining and irrigation. The bladder was sutured in 2 layers using 0 or 1 chromic catgut. In the control group povidone-iodine was not used. Both groups received pre-operative antibiotics 30 minutes before incision and post-operative for 5 days. Pre-operative, intraoperative and post-operative data were collected on a standardized data collection forms. Post-operative irrigation was done for 9 to 12 days after which the catheter was removed as an outpatient. Patients were followed up in the urological clinic at 1 week, 2weeks and at 4 weeks post-operatively to assess whether they had developed surgical site infections according to CDC guidelines. Data was analyzed using SPSS version 16.
Results: The patients mean age was 71.1 in the control group and 71.4 in the study group with no statistically significant difference (t=0.318; p=0.75; df=126.89). The overall surgical infection rate was 16.2%. In the control group 15 out of 65 patients (23.1%) developed SSIs. While in the study group 6 out of 65 patients (9.2%) developed SSIs. The difference in the rates of SSI between the two groups was statistically significant (÷²; p<0.05; df=126.89) Escherichia coli was the most predominant organism 13/37 (35%), streptococcus 7/37 (18.9), Citrobacter koseri 5/37 (13.5%), Klebsiella sp 4/37 (10.8%). Escherichia coli, Streptococcus and Citrobacter were sensitive to ciprofloxacin; Pantoea agglomerans was sensitive to ceftazidime while Staphylococcus coagulase was sensitive to imipenem. Enterobacter cloace was resistant to all antibiotics used.
Conclusion: The study found that irrigating the bladder with 1% povidone-iodine resulted in significant reduction in post prostatectomy surgical site infection, Escherichia coli as the most common causative organism, reduced morbidity and post-operative hospital stay in the povidone iodine group.

Key words: Benign prostatic hyperplasia, transvesical prostatectomy, povidone iodine, surgical site infections.