***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND  Postoperative surgical site infections are one of the most frequent complications after open abdominal surgery , and triclosan-coated sutures were developed to reduce their occurrence . The aim of the PROUD trial was to obtain reliable data for the effectiveness of triclosan-coated PDS Plus sutures for abdominal wall closure , compared with non-coated PDS II sutures , in the prevention of surgical site infections . METHODS This multicentre , r and omised controlled group-sequential superiority trial was done in 24 German hospitals . Adult patients ( aged ≥18 years ) who underwent elective midline abdominal laparotomy for any reason were eligible for inclusion . Exclusion criteria were impaired mental state , language problems , and participation in another intervention trial that interfered with the intervention or outcome of this trial . A central web-based r and omisation tool was used to r and omly assign eligible participants by permuted block r and omisation with a 1:1 allocation ratio and block size 4 before mass closure to either triclosan-coated sutures ( PDS Plus ) or uncoated sutures ( PDS II ) for abdominal fascia closure . The primary endpoint was the occurrence of superficial or deep surgical site infection according to the Centers for Disease Control and Prevention criteria within 30 days after the operation . Patients , surgeons , and the outcome assessors were masked to group assignment . Interim and final analyses were by modified intention to treat . This trial is registered with the German Clinical Trials Register , number DRKS00000390 . FINDINGS Between April 7 , 2010 , and Oct 19 , 2012 , 1224 patients were r and omly assigned to intervention groups ( 607 to PDS Plus , and 617 to PDS II ) , of whom 1185 ( 587 PDS Plus and 598 PDS II ) were analysed by intention to treat . The study groups were well balanced in terms of patient and procedure characteristics . The occurrence of surgical site infections did not differ between the PDS Plus group ( 87 [ 14·8 % ] of 587 ) and the PDS II group ( 96 [ 16·1 % ] of 598 ; OR 0·91 , 95 % CI 0·66 - 1·25 ; p=0·64 ) . Serious adverse events also did not differ between the groups-146 of 583 ( 25·0 % ) patients treated with PDS Plus had at least one serious adverse event , compared with 138 of 602 ( 22·9 % ) patients treated with PDS II ; p=0·39 ) . INTERPRETATION Triclosan-coated PDS Plus did not reduce the occurrence of surgical site infection after elective midline laparotomy . Innovative , multifactorial strategies need to be developed and assessed in future trials to reduce surgical site infections . FUNDING Johnson & Johnson Medical Limited A r and omized controlled trail in 374 patients requiring emergency appendicectomy  to determine the value of topical ampicillin and antiseptic solution of chlorhexidine and cetyl trimethyl ammonium bromide ( Savlon ) in preventing wound infection is reported . The application of 1 g of ampicillin powder to the wound significantly reduced wound infection in perforated appendicitis , but not in unperforated appendicitis . Wound irrigation with 1 per cent cetyl trimethyl ammonium bromide was ineffective in preventing wound infection in all grade s of appendicitis . When wound contamination is difficult to avoid , as in perforated appendicitis , topical ampicillin should be used to reduce the rate of wound infection Objective To determine the clinical effectiveness of wound edge protection devices in reducing surgical site infection  after abdominal surgery . Design Multicentre observer blinded r and omised controlled trial . Participants Patients undergoing laparotomy at 21 UK hospitals . Interventions St and ard care or the use of a wound edge protection device during surgery . Main outcome measures Surgical site infection within 30 days of surgery , assessed by blinded clinicians at seven and 30 days and by patient ’s self report for the intervening period . Secondary outcomes included quality of life , duration of stay in hospital , and the effect of characteristics of the patient and operation on the efficacy of the device . Results 760 patients were enrolled with 382 patients assigned to the device group and 378 to the control group . Six patients in the device group and five in the control group did not undergo laparotomy . Fourteen patients , seven in each group , were lost to follow-up . A total of 184 patients experienced surgical site infection within 30 days of surgery , 91/369 ( 24.7 % ) in the device group and 93/366 ( 25.4 % ) in the control group ( odds ratio 0.97 , 95 % confidence interval 0.69 to 1.36 ; P=0.85 ) . This lack of benefit was consistent across wound assessment s performed by clinicians and those reported by patients and across all secondary outcomes . In the secondary analyses no subgroup could be identified in which there was evidence of clinical benefit associated with use of the device . Conclusions Wound edge protection devices do not reduce the rate of surgical site infection in patients undergoing laparotomy , and therefore their routine use for this role can not be recommended . Trial registration Current Controlled Trials IS RCT N This study sought to determine in a district general hospital ( a ) the frequency and nature of bacterial contamination at operation , ( b ) the incidence of consequent infection and ( c ) the prophylactic effect , if any , of inter‐parietal povidone‐iodine against postoperative wound infection This study compared the efficacy of a single intravenous dose of Cefazolin alone or combined with an antibiotic containing preclosure-irrigation solution in patients undergoing cesarean section . A total of 308 patients were prospect ively assigned to two groups by r and omization . Group I received two grams of Cefazolin IV and abdomino-peritoneal irrigation with saline . Group II received one gram of Cefazolin IV and one gram in the saline irrigation solution . The rate of total postoperative morbidity was 2.3 times higher in Group I compared to Group II ( 16/154 or 10.4 % vs 7/154 or 4.5 % ) and morbidity at the operative site was six times higher ( 13/154 or 8.4 % vs 2/154 or 1.3 % ) One hundred ninety patients with peritonitis at the time of abdominal surgery were allocated at r and om to systemic antibiotic treatment alone or systemic antibiotic treatment combined with topical application of antibiotics in the wound at the time of wound closure . The overall wound infection rate was 17 percent without significant difference between the two treatment groups ( P>0.80 ) To evaluate syringe pressure irrigation of the surgical wound to decrease its infection after appendectomy , we design ed a r and omized control trial at the Emergency Department of Mexico City General Hospital , including 350 patients with acute abdomen suggestive of appendicitis , without any other infection clinical ly evident . The trial was r and omized into 2 groups . Group I patients received prophylactic systemic antibiotics before surgery . Group II patients received the same prophylactic systemic antibiotics plus syringe pressure irrigation of the surgical wound with 300 ml of saline solution using a 20-ml syringe with 19-gauge intravenous ( IV ) catheter to measure the incidence of postoperative wound infection . In our results , 283 patients had appendicitis . Of these , 188 were uncomplicated ( 66.4 % ) and 95 ( 33.6 % ) were complicated . Of the complicated cases , 40 were assigned to group I , and of these , 29 ( 72.5 % ) developed wound infection . In group II there were 55 patients and only 9 ( 16.3 % ) developed wound infection after syringe pressure irrigation [ p= 0.000001 ; 95 % confidence interval ( CI ) = 0.02–0.22 ] . We conclude that syringe pressure irrigation of the surgical wound after appendectomy contributes significantly to decrease the incidence of postoperative wound infection in complicated cases . It is a cheap , safe , and accessible method in any surgical room In this prospect i ve , r and omized study of 187 patients undergoing a variety of general surgical procedures , no significant difference could be demonstrated between those patients whose wounds were irrigated with normal saline solution and those whose wounds were irrigated with povidone-iodine . The potential of an alpha or a beta error is discussed No carefully controlled trial of the use of topical ampicillin in cholecystectomy wounds has been described . A series of 100 consecutive cholecystecomies performed by one surgeon using this drug in a double‐blind manner is reported . The efficacy of topical ampicillin in lowering the wound‐infection rate as shown by other authors is not confirmed The  wound-infection rate after abdominal operations was compared in 113 patients r and omly allocated to an  untreated control group , a group receiving preoperative lincomycin and tobramycin , or a group receiving local instillation of povidone-iodine . The wound-infection rate was 8.1 % in 37 patients receiving antibiotics , 42.1 % in 38 untreated controls , and 39.5 % in 38 patients in the povidone-iodine group The effect of povidone iodine on wound sepsis following gastrointestinal surgery was studied in a trial involving 153 patients of whom 72 had their wounds sprayed with povidone iodine dry powder ( Disadine DP ) and 81 acted as a control group . The infection rate of 9·9 per cent in the patients treated with povidone iodine was significantly lower than that of 24·4 per cent in the control group ( P<0·05 ) . Bacterial contamination of the wound at the time of operation was shown to be of importance , being associated with a 52 per cent infection rate in the control group . However , spraying of contaminated wounds with povidone iodine  reduced the infection rate to the significantly lower level of 11 per cent ( P<0·05 ) . We conclude that povidone iodine is a safe and effective means of reducing wound sepsis following gastrointestinal surgery A r and omized stratified clinical trial of topical povidone‐iodine in 627 patients undergoing abdominal procedures demonstrated a reduction in postoperative wound sepsis  in female patients , in patients receiving subcutaneous low dose  heparin and during the first quarter of the trial when the infection rate in control subjects was high . Overall , there was no significant reduction in wound sepsis after administration of povidone‐iodine due mainly to a high infection rate in povidone‐iodine treated male appendix operations where , by chance , there was an increased incidence of contamination with Bacteroides fragilis Single doses of clindamycin hydrochloride and gentamicin sulfate given preoperatively , combined with intraoperative topical application of povidone-iodine were given to patients with perforated or gangrenous appendicitis . The incidence of wound sepsis was reduced from 36 % to 5 % ; severe infections were reduced from 25 % to 0 % when compared with a control untreated group of patients . When used alone , povidone-iodine had little effect in these patients . No toxic effects of the antibiotics or antiseptic were recorded nor were any resistant strains of pathogenic organisms grown from cultures OBJECTIVE To evaluate whether saline wound irrigation decreases the incidence of wound infection following abdominal gynecologic surgery .  METHOD In this prospect i ve r and omized study , 104 patients underwent wound irrigation before wound closure following abdominal gynecologic surgery and 102 patients did not .  RESULTS There were no significant differences between the 2 groups in patient characteristics or in factors influencing the incidence of wound infection after abdominal gynecologic surgery . The incidence of wound infection was 10.6 % among women who underwent wound irrigation and 9.8 % among those who did not , and the difference was not statistically significant . CONCLUSION Saline wound irrigation before abdominal wall closure is not helpful in decreasing the incidence of wound infection after abdominal gynecologic surgery In a prospect i ve blind trial in patients undergoing intraabdominal surgery , instillation of povodone iodine ( PVI ) solution into the wound failed to reduce the incidence of wound sepsis The effect of using topical povidone-iodine spray in addition to a single dose of intravenous metronidazole was studied in a clinical trial involving 200 patients undergoing appendicectomy . Despite the metronidazole , patients with perforated or gangrenous appendices still had an unacceptably high rate of wound infection . Overall , no benefit result ed from the addition of the povidone-iodine spray . Sub-dividing the patients according to the macroscopic state of the appendix , the degree of bacterial contamination of the operative wound or the depth of subcutaneous fat also failed to reveal any advantage gained by using the antiseptic The aim of this prospect i ve r and omised study was to estimate the effect of saline wound irrigation before wound closure in the prevention of infection following caesarean delivery . Participants with indications for elective or emergency caesarean section were r and omly allocated to two groups . A total of 260 women who underwent wound irrigation before wound closure and 2 
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Subgroup analyses showed that this effect was strongest in colorectal surgery and that IOWI with antibiotic solutions had a stronger effect than irrigation with PVP-I or saline .
Conclusion These results suggest that IOWI before skin closure represents a pragmatic and economical approach to reduce postoperative SSI after abdominal surgery and that antibiotic solutions seem to be more effective than PVP-I solutions or simple saline , and it might be worth to re-evaluate their use for specific indications