Antibiotic prophylaxis in breast cancer surgery: a randomized controlled trial

Purpose To assess the effect of antibiotic prophylaxis on surgical site infection (SSI) rates in women undergoing breast cancer surgery in two tertiary hospitals in Brazil. Methods This was a randomized, double-blind, placebo-controlled, parallel-group clinical trial. A total of 124 women without independent risk factors for SSI were randomly assigned to receive either cefazolin (antibiotic group, n = 62) or placebo (control group, n = 62) as preoperative prophylaxis. After surgery, all surgical wounds were examined once a week, for four weeks, according to the Centers for Disease Control and Prevention definitions and classifications for SSI. Results Baseline characteristics were homogeneous between the two groups. Only one patient in the antibiotic group developed SSI, which was classified as superficial incisional. The overall SSI rate was low, with no significant difference between groups. Conclusion Antibiotic prophylaxis had no significant effect on reducing SSI rates in women without independent risk factors for SSI undergoing breast cancer surgery.(AU)

Effects of the basic fibroblast growth factor and its anti-factor in the healing and collagen maturation of infected skin wound / Efeitos do fator de crescimento de fibroblastos básico e do seu anti-fator na cicatrização e maturação do colágeno de feridas infectadas de pele

PURPOSE: The infection is one of the main factors that affect the physiological evolution of the surgical wounds. The aim of this work is to evaluate the effects of fibroblast growth factor (FGFâ) and anti-FGFâ in the healing, synthesis and maturation of collagen when topically used on infected skin wounds of rats. METHODS: An experimental study was perfomed in 60 male Wistar rats. All animals were divided in two groups (A and B). Each group was divided in three subgroups A1, B1; A2, B2 and A3, B3. After anesthesia with pentobarbital, two open squared wounds (1cm²), 4cm distant to each other, were done in the dorsal skin of all the rats. In group A (n=30) the wounds were contaminated with multibacterial standard solution, and in group B(n=30) the wounds were maintained sterile. These wounds were named F1 (for inflammation analysis) and F2 (for collagen study). The open wounds of A1 and B1 rats were topically treated with saline solution, A2 and B2 were treated with FGFâ and subgroups A3 and B3 were treated with FGFâ and anti-FGFâ. The rats were observed until complete epitelization of F2 wounds for determination of healing time and the expression of types I and III collagen, using Picro Sirius Red staining. Inflammatory reaction in F1 wounds was studied using hematoxilineosin staining. The three variable was measured by the Image Pro-Plus Média Cybernetics software. The statistical analysis was performed by ANOVA and Tukey test, considering p<0.05 as significant. RESULTS: It was observed that infection retarded significantly (p<0.05) the time of wound scarring and the topical application of FCFb reverted the inhibition of healing caused by bacteria. The inflammatory reaction was greater in the subgroup B2 than in B1 and A3, and the difference was significant (p<0.05). It was observed greater expression of type I collagen in all the subgroups treated with FCFb, when compared with the untreated subgroups. Type III collagen was significantly...(AU)

OBJETIVO: Avaliar os efeitos do fator de crescimento de fibroblastos básico (FCFâ) e do anti-FCFâ na cicatrização e maturação do colágeno em feridas infectadas na pele de ratos. MÉTODOS: Um estudo experimental foi realizado em 60 ratos Wistar, divididos em dois grupos (A e B). Cada grupo foi divididos em 03 subgrupos A1,B1; A2,B2 e A3,B3. Após anestesia com pentobarbital sódico intraperitoneal, foram feitas duas feridas abertas de 1cm² na pele no dorso distando 4cm uma da outra. Essas feridas foram denominadas feridas F1 (para análise inflamatória) e F2 (para estudo do colágeno). No grupo A(n=30), as feridas foram contaminadas com solução multibateriana e no grupo B (n=30) as feridas não foram contaminadas. As feridas receberam tratamento tópico com aplicação única. Nos subgrupos A1 e B1 foram tratadas com solução salina tópica, as dos subgrupos A2 e B2 foram tratadas com o FCFâ e nos subgrupos A3 e B3 foram tratadas com FCFâ e com o anti-FCFâ. Os dados formam analisados pelos testes ANOVA de Tukey, considerando p<0,05 como significante. RESULTADOS: A infecção retardou de modo significante o tempo de cicatrização e a aplicação do FCFâ foi capaz de reverter a inibição da cicatrização provocada pela infecção(p<0.05). A resposta inflamatória foi maior nos grupos tratados com o FCFâ, e a aplicação do anti-FCFâ inibiu a reação inflamatória(p<0.05). Houve aumento significante dos colágenos tipo I e III em todos os subgrupos tratados com FCFâ, comparando com os não tratados, sendo a expressão do tipo I mais intensa do que do tipo III (p<0.05). A aplicação do anti-FCFâ inibiu a expressão das moléculas do colágeno. CONCLUSÕES: O FCFâ foi capaz de acelerar a cicatrização de feridas abertas infectadas e contribui para a maturação do colágeno, ao aumentar a expressão do colágeno tipo I, fenômeno que foi atenuado pela ação do anti-FCFâ.(AU)

Simvastatin improves the healing of infected skin wounds of rats / A sinvastatina melhora a cicatrização de feridas infectadas da pele de ratos

PURPOSE: This study explores the potential of the simvastatin to ameliorate inflammation and infection in open infected skin wounds of rats. METHODS: Fourteen Wistar rats weighing 285±12g were used. The study was done in a group whose open infected skin wounds were treated with topical application of sinvastatina microemulsion (SIM, n=7) and a second group with wounds treated with saline 0.9 percent (SAL, n=7). A bacteriological exam of the wounds fluid for gram positive and gram negative bacteria, the tecidual expression of TNFá and IL-1â by imunohistochemical technique, and histological analysis by HE stain were performed. RESULTS: The expression of TNFa could be clearly demonstrated in lower degree in skin wounds treated with simvastatin (668.6 ± 74.7 ìm²) than in saline (2120.0 ± 327.1 ìm²). In comparison, wound tissue from SIM group displayed leukocyte infiltration significantly lower than that observed in SAL group (p<0.05). Culture results of the samples taken from wound fluid on fourth post treatment day revealed wound infection in only one rat of group simvastatin (SIM), where Proteus mirabilis, Escherchia coli and Enterobacter sp were isolated. In the rats whose wounds were treated with saline (SAL), polymicrobial infection with more than 100,000 CFU/g was detected in all the wounds. CONCLUSION: In addition to its antiinflammatory properties, the protective effects of simvastatin in infected open skin wounds is able to reduce infection and probably has antibacterial action. The potential to treat these wounds with statins to ameliorate inflammation and infection is promising.(AU)

OBJETIVO: O presente estudo avaliou o potencial da sinvastatina para atenuar a inflamação e a infecção em feridas abertas infectadas de pele de ratos. MÉTODOS: Foram utilizados 14 ratos Wistar pesando 285±12g. O estudo foi realizado com um grupo de animais cujas feridas abertas infectadas foram tratadas com aplicação tópica de sinvastatina microemulsão (SIM, n=7) e um segundo grupo com feridas tratadas com solução salina 0,9 por cento (SAL n=7). Foi realizado exame bacteriológico do fluido das feridas para detecção de bactérias gram positivas e negativas, a expressão tecidual de TNFá e IL-1â por imunohistoquímica e análise histológica pela coloração H-E. RESULTADOS: A expressão do TNFa pode ser claramente demonstrada em menor grau nas feridas de pele tratadas com sinvastatina (668.6 ± 74.7 ìm²) do que no grupo salina (2120.0 ± 327.1 ìm²). Em comparação, os tecidos das feridas do grupo SIM mostrou infiltração leucocitária significantemente menor do que a observada no grupo SAL (p<0,05). O resultado das culturas realizadas no fluido das feridas no 4º dia de tratamento revelou infecção em apenas um rato do grupo sinvastatina (SIM), onde Proteus mirabilis, Escherchia coli e Enterobacter sp foram isolados. Nos ratos cujas feridas foram tratadas com solução salina (SAL), infecção polimicrobiana com mais de 100,000 UFC/g foi detectada em todas as feridas. CONCLUSÃO: Além de suas propriedades antiinflamatórias, o efeito protetor da sinvastatina em feridas abertas e infectadas de pele é capaz de reduzir a infecção e provavelmente tem ação antibacteriana. O potencial da droga para atenuar inflamação e infecção de feridas é promissor.(AU)