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Einfluss der Darmvorbereitung auf Wundinfektionen und Anastomoseninsuffizienzen bei elektiven Kolonresektionen: Ergebnisse einer retrospektiven Studie mit 260 Patienten. Chirurg 2020; 91:491-501. [DOI: 10.1007/s00104-019-01099-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Görig T, Dittmann K, Kramer A, Heidecke CD, Diedrich S, Hübner NO. Active involvement of patients and relatives improves subjective adherence to hygienic measures, especially selfreported hand hygiene: Results of the AHOI pilot study. Antimicrob Resist Infect Control 2019; 8:201. [PMID: 31890157 PMCID: PMC6909614 DOI: 10.1186/s13756-019-0648-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/08/2019] [Indexed: 11/17/2022] Open
Abstract
Background The prevention of nosocomial infections requires participation from the patients themselves. In the past, however, patients have been apprehensive to point out hygiene-relevant behaviour to the personnel. In the project AHOI, the possibilities of active patient involvement in infection prevention are identified, tested and realized. The goal is a prevention strategy based upon three dimensions: “adherence”, “empowerment” and “acceptance”. “AHOI” stands for the “Activation of patients, persons in need of care and care givers for a Hygiene-conscious participatiOn in Infection control”. Results from the AHOI pilot study on the implementation of a multimodal intervention bundle are reported. Methods In 2017, a two-stage patient survey was conducted on two surgical wards for 14 weeks. In addition to the intervention bundle, acceptance, adherence and empowerment regarding individual hygiene behaviour and perception were evaluated. The bundle included an AHOI-welcome-box with an informational and entertaining brochure and supportive incentives. Furthermore, multiple visual materials like video presentations for patients’ bedside TV, posters and visual reminders in the patients’ bedrooms and sanitary facilities were installed. Results 179 respondents were surveyed at admission, 139 at discharge and 133 at both time points. Almost all respondents wanted to contribute to infection control. The AHOI project was well accepted by patients. Two-thirds wanted to be more involved. More than a third expected a negative response from staff after pointing out hygiene deficiencies. Four respondents observed a deficiency in hygiene with healthcare personnel and reported a very positive reaction once this was communicated to the personnel. More than four-fifths of the respondents felt well integrated and adequately informed post intervention. The feeling of active involvement correlated significantly with subjective participation and adherence to hygienic measures, especially self-reported hand disinfection. Conclusion The results demonstrated that the required inclusion of patients in infection control is possible with AHOI. Active involvement of patients and relatives is associated with improvements in adherence to infection prevention measures.
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Affiliation(s)
- Tillmann Görig
- 1Central Unit for Infection Prevention and Control, Universitätsmedizin Greifswald, Walther-Rathenau-Str. 49A, Greifswald, 17475 Germany
| | - Kathleen Dittmann
- 1Central Unit for Infection Prevention and Control, Universitätsmedizin Greifswald, Walther-Rathenau-Str. 49A, Greifswald, 17475 Germany
| | - Axel Kramer
- 2Institute of Hygiene and Environmental Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Claus-Dieter Heidecke
- 3Polyclinic and Clinic for General Surgery, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Greifswald, Germany.,4Medical Chairman of Universitätsmedizin Greifswald, Greifswald, Germany
| | - Stephan Diedrich
- 3Polyclinic and Clinic for General Surgery, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Nils-Olaf Hübner
- 1Central Unit for Infection Prevention and Control, Universitätsmedizin Greifswald, Walther-Rathenau-Str. 49A, Greifswald, 17475 Germany
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Popp W, Alefelder C, Bauer S, Daeschlein G, Geistberger P, Gleich S, Herr C, Hübner NO, Jatzwauk L, Kohnen W, Külpmann R, Lemm F, Loczenski B, Spors J, Walger P, Wehrl M, Zastrow KD, Exner M. Air quality in the operating room: Surgical site infections, HVAC systems and discipline - position paper of the German Society of Hospital Hygiene (DGKH). GMS HYGIENE AND INFECTION CONTROL 2019; 14:Doc20. [PMID: 32047719 PMCID: PMC6997799 DOI: 10.3205/dgkh000335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In recent years, there has been an ongoing discussion about the value of laminar airflow (LAF=low turbulence displacement ventilation) in the operating room for prevention of surgical site infections (SSI). Some publications, e.g., from the WHO, issued the demand to no longer build LAF ceilings in operating rooms. The present statement deals critically with this position and justifies the use of LAF ceilings in different ways: Many of the papers cited by the WHO and others for the case against LAF do not provide reliable data.The remaining studies which might be used for answering the question give quite different results, also in favor of LAF.The size of the LAF ceiling in many studies is not given or mostly too small in comparison to actual technical requirements.LAF in different countries can mean quite different techniques (e.g., the US in comparison to Germany) so that the results of studies that do not take this into account may not be comparable.LAF has positive effects in terms of reducing particulate and bacterial load, associated with increased airflow in the surgical working area. A reduction of carcinogenic substances in the air may also be assumed, which would increase workers' safety. Thus, this paper recommends building LAF ceilings in the future as well, depending on the operations intended. Further, this paper gives an overview of possible reasons for surgical site infections and highlights the importance of discipline in the operating theatre.
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Affiliation(s)
- Walter Popp
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | | | - Sonja Bauer
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | | | | | - Sabine Gleich
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | - Caroline Herr
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | | | - Lutz Jatzwauk
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | | | | | | | | | - Jörg Spors
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | - Peter Walger
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | - Markus Wehrl
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | | | - Martin Exner
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
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54
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[Effects of comorbidities on wound healing]. MMW Fortschr Med 2019; 161:54-59. [PMID: 31773597 DOI: 10.1007/s15006-019-1157-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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55
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Schuler F, Kampmeier S, Lanckohr C. [63-year-old male with positive VRE anamnesis, elective indications for surgery and during the course VRE bacteremia : Preparation for the medical specialist examination: part 33]. Anaesthesist 2019; 68:236-238. [PMID: 31624876 DOI: 10.1007/s00101-019-00660-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- F Schuler
- Institut für Medizinische Mikrobiologie, Universitätsklinikum Münster, Domagkstr. 10, 48149, Münster, Deutschland.
| | - S Kampmeier
- Institut für Hygiene, Universitätsklinikum Münster, Münster, Deutschland
| | - C Lanckohr
- Institut für Hygiene, Universitätsklinikum Münster, Münster, Deutschland
- Antibiotic Stewardship Team, Universitätsklinikum Münster, Münster, Deutschland
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Müller D, Kaiser D, Sairanen K, Studhalter T, Uçkay İ. Antimicrobial Prophylaxis for the Prevention of Surgical Site Infections in Orthopaedic Oncology - A Narrative Review of Current Concepts. J Bone Jt Infect 2019; 4:254-263. [PMID: 31966954 PMCID: PMC6960022 DOI: 10.7150/jbji.39050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 08/27/2019] [Indexed: 12/12/2022] Open
Abstract
The incidence of surgical site infections (SSIs) after elective tumour orthopaedic surgery in adults is higher than non-oncologic orthopaedic surgery. Their causative microorganisms and antibiotic susceptibilities are also different from the non-oncologic cases; with no apparent predictable microbiological patterns. Clinicians continue to struggle to tailor the optimal prophylactic regimen for the very heterogeneous group of tumour patients. Many clinicians thus prolong the first-and second-generation cephalosporin agents, while a minority chooses to broaden the antimicrobial spectrum by combination prophylaxis. The variability in current practices and surgical techniques is enormous, even within the same setting. The scientific literature lacks adequate retrospective case-studies and there is currently only one prospective randomized trial. In this narrative review, we discuss various perioperative antibiotic concepts in oncologic orthopaedic surgery, including a summary of the state-to-the-art, opinions and difficulties related to the different prophylactic strategies.
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Affiliation(s)
- Daniel Müller
- Department of Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Dominik Kaiser
- Department of Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Kati Sairanen
- Unit of Clinical and Applied Research, Balgrist University Hospital, Zurich, Switzerland
| | - Thorsten Studhalter
- Infectious Diseases and Infection Control, Balgrist University Hospital, Zurich, Switzerland
| | - İlker Uçkay
- Unit of Clinical and Applied Research, Balgrist University Hospital, Zurich, Switzerland
- Infectious Diseases and Infection Control, Balgrist University Hospital, Zurich, Switzerland
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Lampl B. Staples Can Have Advantages. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:661. [PMID: 31617482 DOI: 10.3238/arztebl.2019.0661a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Maurer E. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:661-662. [PMID: 31617483 PMCID: PMC6832105 DOI: 10.3238/arztebl.2019.0661b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Elisabeth Maurer
- *Klinik für Viszeral-, Thorax- und Gefäßchirurgie Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Marburg, Germany
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[Bowel preparation for elective colorectal surgery in Germany 2017 : Results of a survey among members of the German Society of General and Visceral Surgery]. Chirurg 2019; 90:564-569. [PMID: 30607461 DOI: 10.1007/s00104-018-0773-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The morbidity after colorectal resection is still high. Perioperative i.v. antibiotic administration has become established as the standard to decrease the wound infection rate. An ongoing discussion is the status of preoperative mechanical bowel preparation. There seems to be evidence that mechanical bowel preparation in combination with administration of oral non-resorbable antibiotics significantly decreases the rate of anastomotic leakage and postoperative wound infections. OBJECTIVE In order to obtain an overview on the state of preoperative preparation before elective colorectal surgery in Germany, a survey was initiated among the members of the German Society of General and Visceral Surgery. MATERIAL AND METHODS In March 2017 the 5200 members of the German Society of General and Visceral Surgery (DGAV) received via email a link to an online survey on bowel preparation before elective colorectal surgery. RESULTS A total of 557 colleagues answered the questionnaire online. Mechanical bowel preparation with orthograde lavage was the predominant method for bowel preparation prior to colon resection in over 50%. In rectal surgery with primary anastomosis and planned protective stoma, mechanical bowel preparation with orthograde lavage dominated with 76.5%. An oral antibiotic administration alone and in combination with mechanical bowel preparation for colon resection was used by less than 10% and 2%, respectively and ca. 11 % for rectal surgery both with and without mechanical bowel preparation. CONCLUSION In contrast to the evidence in the current literature to carry out preoperative mechanical preparation of the bowel in combination with an oral antibiotic administration prior to colorectal resection, in practice these recommendations have not become established among the participants of this survey.
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Balakirski G, Felcht M, Bayer H, Schmitt L. Analyse des Status quo der perioperativen Antibiotikaprophylaxe in der Dermatochirurgie in Deutschland: Ergebnisse der DESSI-Studie. J Dtsch Dermatol Ges 2019; 17:703-715. [PMID: 31364303 DOI: 10.1111/ddg.13864_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/23/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Galina Balakirski
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum der Rheinischen Friedrich-Wilhelms-Universität Bonn
| | - Moritz Felcht
- Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim der Universität Heidelberg, Exzellenzzentrum Dermatologie des Landes Baden-Württemberg, und European Center for Angioscience (ECAS), Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim
| | - Hans Bayer
- Klinik für Dermatologie und Venerologie, Universitätsklinik Freiburg
| | - Laurenz Schmitt
- Klinik für Dermatologie und Allergologie, Universitätsklinikum der RWTH Aachen
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Balakirski G, Felcht M, Bayer H, Schmitt L. Analysis of the status quo of perioperative antibiotic prophylaxis in dermatosurgery in Germany: results of the DESSI-study. J Dtsch Dermatol Ges 2019; 17:703-713. [PMID: 31124600 DOI: 10.1111/ddg.13864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/23/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Perioperative antibiotic prophylaxis (PAP) is recommended for the prevention of postoperative infections by the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute. However, how PAP is currently used in the field of dermatosurgery in Germany is unclear. METHODS All members of the German Society for Dermatosurgery (DGDC) were asked to participate in a web-based survey in order to investigate the use of PAP by German dermatological surgeons. RESULTS 78 DGDC members completed the questionnaire. Of these, 89.7 % (70/78) were medical specialists with a median work experience of 15 years in the field of dermatosurgery, and 53.8 % (42/78) of the respondents regularly use PAP in dermatosurgery. Of these, 35.7 % (15/42) reported that they perform PAP for immunocompromised patients. Only a small proportion of skin surgeons stated that they administer PAP parenterally (5.9 %, 4/67). The most commonly used drug was cephalosporin cefuroxime. The duration of the PAP varied between single-dose and prolonged administration for more than five days. CONCLUSION Currently, the use of PAP in dermatosurgical procedures in Germany is not standardized. Prospective randomized dermatosurgical studies are needed in order to investigate whether the PAP recommendations of KRINKO are applicable to the field of dermatological surgery.
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Affiliation(s)
- Galina Balakirski
- Department of Dermatology and Allergology, University Hospital of Bonn, Bonn, Germany
| | - Moritz Felcht
- Department of Dermatology, Venereology and Allergology, University Medicine Mannheim, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - Hans Bayer
- Department of Dermatology and Venereology, University Hospital of Freiburg, Freiburg, Germany
| | - Laurenz Schmitt
- Department of Dermatology and Allergology, University Hospital of RWTH Aachen, Aachen, Germany
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Maurer E, Reuss A, Maschuw K, Aminossadati B, Neubert T, Schade-Brittinger C, K. Bartsch D. Superficial Surgical Site Infection Following the Use of Intracutaneous Sutures Versus Staples. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:365-371. [PMID: 31315799 PMCID: PMC6647811 DOI: 10.3238/arztebl.2019.0365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 01/03/2019] [Accepted: 04/15/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Superficial wound infections after gastrointestinal surgery markedly impair the affected patients' quality of life. As it is still unknown which method of skin closure is best for the reduction of wound infections in elective gastrointestinal sur- gery, we compared the frequency of wound infections after intracutaneous suturing versus skin stapling. METHODS In a prospective, randomized, single-center study, patients undergoing elective gastrointestinal surgery were intraoperatively randomized to skin closure either with an intracutaneous suture or with staples. The primary endpoint-the occurrence of a grade A1 wound infection within 30 days of surgery-was evaluated according to the intention-to-treat principle. RESULTS Out of a total of 280 patients, 141 were randomized to intracutaneous suturing and 139 to stapling. The groups did not differ significantly with respect to age, sex, or ASA classification. 19 of the 141 patients in the intracutaneous suturing group (13.5%) had a grade A1 wound infection, compared with 23 of 139 in the stapling group (16.6%) (odds ratio [OR]: 0.79; 95% confidence interval: [0.41; 1.52]; p = 0.47). A multiple regression analysis revealed that the type of surgery (colorectal vs. other), the approach, and the incision length were independent risk factors for a grade A1 wound infection. When wound dehiscences were additionally considered, wound complications were found to have arisen significantly more often in the stapling group than in the intracutaneous suturing group (16.3% [23/141] versus 30.2% [42/139], OR: 0.45 [0.25; 0.80]; p = 0.006). CONCLUSION In elective gastrointestinal surgery, intracutaneous suturing was not found to be associated with a lower rate of superficial wound infections than skin stapling, but fewer wound dehiscences occurred in the intracutaneous suturing group.
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Affiliation(s)
- Elisabeth Maurer
- Department of Visceral, Thoracic and Vascular Surgery Universität Gießen und Marburg GmbH, Marburg
| | - Alexander Reuss
- Clinica Trials Coordination Center (KKS), Philipps-Universität Marburg, Marburg
| | - Katja Maschuw
- Department of Visceral, Thoracic and Vascular Surgery Universität Gießen und Marburg GmbH, Marburg
| | - Behnaz Aminossadati
- Clinica Trials Coordination Center (KKS), Philipps-Universität Marburg, Marburg
| | - Thomas Neubert
- Department of Visceral, Thoracic and Vascular Surgery Universität Gießen und Marburg GmbH, Marburg
| | | | - Detlef K. Bartsch
- Department of Visceral, Thoracic and Vascular Surgery Universität Gießen und Marburg GmbH, Marburg
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Schuler F, Lanckohr C, Pillukat MH, Scherf R, Mellmann A. [Hygiene aspects of multidrug-resistant pathogens in the operating room and intensive care unit]. Anaesthesist 2019; 68:329-340. [PMID: 31049601 DOI: 10.1007/s00101-019-0594-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The major multidrug-resistant pathogens (MRE) in human medicine are methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and multidrug-resistant Gram-negative rod bacteria (MRGN). MRE are a very heterogeneous group with respect to epidemiology and therapeutic or hospital hygiene consequences. After MRSA played an important role among MREs at the beginning of the twenty-first century, VRE and MRGN have come to the fore in recent years. During work in the operating room and on the intensive care unit, there are many possibilities for transmission of MRE between the patient environment and the patient, especially via the hands, e. g. during intubation or catheterization in vessels, tissues or the urinary tract. For this reason, hand and surface hygiene is of particular relevance in the prevention of nosocomial colonization or infection, in particular with MRE.
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Affiliation(s)
- F Schuler
- Institut für Medizinische Mikrobiologie, Universitätsklinikum Münster, Domagkstr. 10, 48149, Münster, Deutschland.
| | - C Lanckohr
- Institut für Hygiene, Universitätsklinikum Münster, Robert-Koch-Straße 41, 48149, Münster, Deutschland
| | - M Hendrik Pillukat
- Institut für Hygiene, Universitätsklinikum Münster, Robert-Koch-Straße 41, 48149, Münster, Deutschland
| | - R Scherf
- Institut für Hygiene, Universitätsklinikum Münster, Robert-Koch-Straße 41, 48149, Münster, Deutschland
| | - A Mellmann
- Institut für Hygiene, Universitätsklinikum Münster, Robert-Koch-Straße 41, 48149, Münster, Deutschland
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Hauk L. Guideline for sterile technique. AORN J 2018; 108:P10-P12. [DOI: 10.1002/aorn.12409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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65
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[Surgical treatment of bites]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2018; 30:321-341. [PMID: 30209521 DOI: 10.1007/s00064-018-0563-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/21/2018] [Accepted: 06/07/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Thorough and profound debridement for acute bite injuries while sparing nerves, vessels and tendons. INDICATIONS Acute traumatic and late presented bite injuries. CONTRAINDICATIONS General contraindication for anesthesia or surgery. SURGICAL TECHNIQUE Extensive flabellate local anesthesia/general anesthesia, wound irrigation using 0.9% NaCl or antiseptic solutions, removal of avital tissues, wound debridement, wound edge excision, anew extensive irrigation, drainage if necessary, wound closure where applicable (except older or punctual deep injuries), bandage, elastic wrapping and immobilization. If necessary, plastic surgery with coverage of remaining defects. POSTOPERATIVE MANAGEMENT Immobilization with initially daily wound evaluation, removal of drainage/loop on postoperative day 2; if necessary, antibiotic therapy with amoxicillin and clavulanic acid in high-risk wounds (e.g., puncture wounds, joint or bone involvement, extensive soft tissue squeezing), suture removal on day 10-12 after surgery. RESULTS Of 142 bite injuries that were treated and retrospectively evaluated, 46% were caused by dogs and 32% by cats. Patients were on average 44 years old; 55% of all dog bites affected women, but 67% of all cat bites. In 48% of the cases, general anesthesia was necessary. The postoperative infection rate was 6.3%.
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Hunger R, Mantke A, Herrmann C, Mantke R. [Triclosan-coated sutures in colorectal surgery : Assessment and meta-analysis of the recommendations of the WHO guideline]. Chirurg 2018; 90:37-46. [PMID: 30203169 DOI: 10.1007/s00104-018-0732-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND In the global guidelines for the prevention of surgical site infections (SSI), the World Health Organization (WHO) recommends the general use of triclosan-coated sutures irrespective of the type of surgical intervention. OBJECTIVE Can this recommendation on the use of triclosan-coated sutures be confirmed by a meta-analysis specifically for colorectal surgery? METHODS Randomized and non-randomized clinical trials comparing triclosan-coated and uncoated sutures for the efficacy in reducing the SSI rate in colorectal surgery were identified by a systematic literature review. In addition, various quality criteria were set for the studies to be included: SSI definition according to the Centers for Disease Control and Prevention (CDC), a priori sample size calculation and a maximum SSI rate of 20%. The odds ratios were pooled using a fixed and random effects model, the 95% confidence intervals (CI) were calculated and subgroup analyses were carried out. RESULTS Included in the meta-analysis were 3 prospective randomized trials (RCT) and 3 non-randomized trials involving a total of 2957 subjects. The average SSI rate was 6.90% (76/1101) in the triclosan group and 9.11% (169/1856) in the control group, resulting in an odds ratio of 0.62 (95% CI: 0.29-1.31). Subgroup analysis showed a decreased risk for SSI in monocentric trials (OR = 0.39, 95% CI: 0.25-0.60) but an increased SSI risk in multicenter trials (OR = 1.75, 95% CI: 1.11-2.77). CONCLUSION Against the background of a moderate to high risk of bias and the partially contradictory findings of the studies, the general recommendation of the WHO on the use of triclosan-coated sutures for colorectal surgery could not be confirmed.
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Affiliation(s)
- R Hunger
- Klinik für Allgemein- und Viszeralchirurgie, Medizinische Hochschule Brandenburg, Städtisches Klinikum Brandenburg, Hochstraße 29, 14770, Brandenburg a.d. Havel, Deutschland.
| | - A Mantke
- Klinik für Allgemein- und Viszeralchirurgie, Medizinische Hochschule Brandenburg, Städtisches Klinikum Brandenburg, Hochstraße 29, 14770, Brandenburg a.d. Havel, Deutschland
| | - C Herrmann
- Klinik für Allgemein- und Viszeralchirurgie, Medizinische Hochschule Brandenburg, Städtisches Klinikum Brandenburg, Hochstraße 29, 14770, Brandenburg a.d. Havel, Deutschland
| | - R Mantke
- Klinik für Allgemein- und Viszeralchirurgie, Medizinische Hochschule Brandenburg, Städtisches Klinikum Brandenburg, Hochstraße 29, 14770, Brandenburg a.d. Havel, Deutschland
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