1
|
Risk factors of incisional hernia after laparoscopic colorectal surgery with periumbilical minilaparotomy incision: a propensity score matching analysis. JOURNAL OF MINIMALLY INVASIVE SURGERY 2022; 25:24-31. [PMID: 35603344 PMCID: PMC8977500 DOI: 10.7602/jmis.2022.25.1.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/08/2022] [Accepted: 03/12/2022] [Indexed: 12/03/2022]
Abstract
Purpose Incisional hernia is one of the most common complications after abdominal surgery conducted through a midline incision. Considerable debate remains regarding the design, comorbidity, suture material, and method. We investigated the risk factors for incisional hernia after laparoscopic colorectal surgery in the presence of limited surgery-related factors. Methods A retrospective study was designed with 541 patients who underwent laparoscopic colorectal surgery performed by a single operator from January 2015 to December 2017. Due to open conversions, other abdominal operations, or follow-up loss, only 445 patients were included in the study. After propensity score matching, 266 patients were included. The study was based on diagnosis of incisional hernia on computed tomography at 6 and 12 months postoperatively. Results Of the 266 total patients, 133 underwent abdominal closure using PDS (Ethicon), while the remaining 133 underwent closure with Vicryl (Ethicon). Of these patients, nine were diagnosed with incisional hernia at the 12-month follow-up six (4.5%) in the Vicryl group and three (2.3%) in the PDS group (p = 0.309). The incidence of incisional hernia was significantly increased in females (odds ratio [OR], 15.233; 95% confidence interval [CI], 1.905–121.799; p = 0.010), in patients with body mass index (BMI) of >25 kg/m2 (OR, 4.740; 95% CI, 1.424–15.546; p = 0.011), and in patients with liver disease (OR, 19.899; 95% CI, 1.614–245.376; p = 0.020). Conclusion BMI of >25 kg/m2, female, and liver disease were significant risk factors for incisional hernia after elective laparoscopic colorectal surgery performed through a transumbilical minilaparotomy incision.
Collapse
|
2
|
Khan R, Yee AL, Gilbert JA, Haider A, Jamal SB, Muhammad F. Triclosan-containing sutures: safety and resistance issues need to be addressed prior to generalized use. APPLIED NANOSCIENCE 2021. [DOI: 10.1007/s13204-021-01979-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
3
|
Bhende S, Burkley D, Nawrocki J. In Vivo and In Vitro Anti-Bacterial Efficacy of Absorbable Barbed Polydioxanone Monofilament Tissue Control Device with Triclosan . Surg Infect (Larchmt) 2018; 19:430-437. [PMID: 29624479 DOI: 10.1089/sur.2017.275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND This study evaluated the in vitro and in vivo anti-bacterial efficacy of STRATAFIX™ Symmetric PDS™ Plus Knotless Tissue Control Devices in comparison with standard absorbable polydioxanone devices lacking triclosan, utilizing challenges by gram-positive and gram-negative bacteria. METHODS The STRATAFIX™ Symmetric PDS™ Plus Knotless Tissue Control Device was tested for in vitro efficacy against Staphylococcus aureus, methicillin-resistant S. aureus (MRSA), S. epidermidis, methicillin-resistant S. epidermidis (MRSE), Klebsiella pneumoniae, and Escherichia coli using a zone of inhibition (ZOI) assay. The ZOI was used to determine: immediate anti-bacterial efficacy at 24 hours, sustained efficacy for as long as 23 days, and stability for as long as 36 months. Bacterial colonization of the device in vitro was evaluated by scanning electron microscopy and enumerating viable adherent bacteria, expressed as colony-forming units (CFU) per centimeter on the device. In vivo evaluations were conducted in guinea pigs and mice where 3 to 4 cm of the test device and the control suture (commercial Quill™ PDO without triclosan) were implanted subcutaneously through separate catheters into opposite sides of the dorsolateral region. Each implantation site was challenged directly through the indwelling catheter with 106 CFU of S. aureus (guinea pigs) or 107 CFU of E. coli (mice). At 48 hours post-implantation, the test device and control suture were explanted for bacterial enumeration. RESULTS The STRATAFIX™ Symmetric PDS™ Plus Knotless Tissue Control Device demonstrated in vitro anti-bacterial activity against all test organisms. This activity was maintained for 11 and 23 days when tested against E. coli and S. aureus, respectively. The device was not colonized by test bacteria in vitro. The anti-bacterial activity remained stable for as long as 36 months of storage at 30°C and 75% relative humidity. In vivo evaluation in animal models demonstrated a 1.16-log reduction in S. aureus and a 1.83-log reduction in E. coli relative to the control device. (p < 0.05) Conclusion: The STRATAFIX™ Symmetric PDS™ Plus Knotless Tissue Control Device exhibited anti-bacterial efficacy in vitro against a wide range of clinically significant bacterial species with long-lasting inhibition of colonization by S. aureus, and E. coli. It inhibited colonization by S. aureus and E. coli in vitro and in vivo. Thus, the STRATAFIX™ Symmetric PDS™ Plus Knotless Tissue Control Device represents a powerful technology to help mitigate one of the risk factors for surgical site infections.
Collapse
|
4
|
Temporal Change of Interleukin-6, C-Reactive Protein, and Skin Temperature after Total Knee Arthroplasty Using Triclosan-Coated Sutures. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9136208. [PMID: 29568771 PMCID: PMC5820568 DOI: 10.1155/2018/9136208] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/20/2017] [Accepted: 11/29/2017] [Indexed: 12/22/2022]
Abstract
The risk of surgical site infections (SSIs) after total knee arthroplasty (TKA) can never be eliminated. Antimicrobial sutures containing triclosan have been used to decrease SSIs, but whether triclosan-coated sutures are effective with TKA is unclear. Between 2011 and 2012, 102 patients randomly assigned to a triclosan or a control group were prospectively assessed. The incidence of SSI within 3 months of surgery, length of hospital stay, pain scale, functional scores, wound condition, and serum inflammatory markers during hospitalization and within 3 months postoperatively were compared. At the final follow-up, there were 2 patients with superficial infections (3.9%) in the control group but none in the triclosan group. Lower serum IL-6 was detected in the triclosan group at 4 weeks and 3 months. The local skin temperature of the knees—recorded at 3 months using infrared thermography—was lower in the triclosan group than in the control group. More precise analytical measurements are needed to investigate local and systemic complications, especially in the early subclinical stage. This prospective, randomized, open-label clinical trial is in the public registry: ClinicalTrials.gov (NCT02533492).
Collapse
|
5
|
Obermeier A, Schneider J, Harrasser N, Tübel J, Mühlhofer H, Pförringer D, von Deimling C, Foehr P, Kiefel B, Krämer C, Stemberger A, Schieker M, Burgkart R, von Eisenhart-Rothe R. Viable adhered Staphylococcus aureus highly reduced on novel antimicrobial sutures using chlorhexidine and octenidine to avoid surgical site infection (SSI). PLoS One 2018; 13:e0190912. [PMID: 29315313 PMCID: PMC5760023 DOI: 10.1371/journal.pone.0190912] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 12/22/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Surgical sutures can promote migration of bacteria and thus start infections. Antiseptic coating of sutures may inhibit proliferation of adhered bacteria and avoid such complications. OBJECTIVES This study investigated the inhibition of viable adhering bacteria on novel antimicrobially coated surgical sutures using chlorhexidine or octenidine, a critical factor for proliferation at the onset of local infections. The medical need, a rapid eradication of bacteria in wounds, can be fulfilled by a high antimicrobial efficacy during the first days after wound closure. METHODS As a pretesting on antibacterial efficacy against relevant bacterial pathogens a zone of inhibition assay was conducted with middle ranged concentrated suture coatings (22 μg/cm). For further investigation of adhering bacteria in detail the most clinically relevant Staphylococcus aureus (ATCC®49230™) was used. Absorbable braided sutures were coated with chlorhexidine-laurate, chlorhexidine-palmitate, octenidine-laurate, and octenidine-palmitate. Each coating type resulted in 11, 22, or 33 μg/cm drug content on sutures. Scanning electron microscopy (SEM) was performed once to inspect the coating quality and twice to investigate if bacteria have colonized on sutures. Adhesion experiments were assessed by exposing coated sutures to S. aureus suspensions for 3 h at 37°C. Subsequently, sutures were sonicated and the number of viable bacteria released from the suture surface was determined. Furthermore, the number of viable planktonic bacteria was measured in suspensions containing antimicrobial sutures. Commercially available sutures without drugs (Vicryl®, PGA Resorba®, and Gunze PGA), as well as triclosan-containing Vicryl® Plus were used as control groups. RESULTS Zone of inhibition assay documented a multispecies efficacy of novel coated sutures against tested bacterial strains, comparable to most relevant S. aureus over 48 hours. SEM pictures demonstrated uniform layers on coated sutures with higher roughness for palmitate coatings and sustaining integrity of coated sutures. Adherent S. aureus were found via SEM on all types of investigated sutures. The novel antimicrobial sutures showed significantly less viable adhered S. aureus bacteria (up to 6.1 log) compared to Vicryl® Plus (0.5 log). Within 11 μg/cm drug-containing sutures, octenidine-palmitate (OL11) showed the highest number of viable adhered S. aureus (0.5 log), similar to Vicryl® Plus. Chlorhexidine-laurate (CL11) showed the lowest number of S. aureus on sutures (1.7 log), a 1.2 log greater reduction. In addition, planktonic S. aureus in suspensions were highly inhibited by CL11 (0.9 log) represents a 0.6 log greater reduction compared to Vicryl® Plus (0.3 log). CONCLUSIONS Novel antimicrobial sutures can potentially limit surgical site infections caused by multiple pathogenic bacterial species. Therefore, a potential inhibition of multispecies biofilm formation is assumed. In detail tested with S. aureus, the chlorhexidine-laurate coating (CL11) best meets the medical requirements for a fast bacterial eradication. This suture coating shows the lowest survival rate of adhering as well as planktonic bacteria, a high drug release during the first-clinically most relevant- 48 hours, as well as biocompatibility. Thus, CL11 coatings should be recommended for prophylactic antimicrobial sutures as an optimal surgical supplement to reduce wound infections. However, animal and clinical investigations are important to prove safety and efficacy for future applications.
Collapse
Affiliation(s)
- Andreas Obermeier
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
- * E-mail:
| | - Jochen Schneider
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Norbert Harrasser
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Jutta Tübel
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Heinrich Mühlhofer
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Dominik Pförringer
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Constantin von Deimling
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Peter Foehr
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Barbara Kiefel
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Christina Krämer
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Axel Stemberger
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Matthias Schieker
- Klinik für Chirurgie, Experimentelle Chirurgie und Regenerative Medizin, Klinikum der Universität München, München, Germany
| | - Rainer Burgkart
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Rüdiger von Eisenhart-Rothe
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| |
Collapse
|
6
|
Leaper DJ, Edmiston CE, Holy CE. Meta-analysis of the potential economic impact following introduction of absorbable antimicrobial sutures. Br J Surg 2017; 104:e134-e144. [PMID: 28093728 DOI: 10.1002/bjs.10443] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/03/2016] [Accepted: 11/03/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite several randomized trials, systematic reviews and meta-analyses that have demonstrated the effectiveness of antimicrobial (triclosan-coated or -impregnated) sutures (TCS), the clinical and economic impact of using these sutures compared with conventional non-antimicrobial-coated absorbable sutures (NCS) remains poorly documented. METHODS An independent systematic review and meta-analysis of all published evidence from January 2005 to September 2016 comparing TCS with NCS was conducted. Surgical-site infection (SSI) was the primary outcome. The results of the meta-analysis were used in a decision-tree deterministic and stochastic cost model, using the National Health Service (NHS England)-based cost of inpatient admissions for infections and differential costs of TCS versus NCS. RESULTS Thirty-four studies were included in the final assessment from an initial 163 identified citations; 20 of 34 studies were randomized, and 17 of 34 reported blinding of physicians and assessors. Using a random-effects model, the odds ratio for SSI in the TCS compared with NCS control groups was statistically significant (odds ratio 0·61, 95 per cent c.i. 0·52 to 0·73; P < 0·001). There was significant heterogeneity (I2 = 49 per cent). Using random-effects event estimates of SSI for TCS and NCS for each individual wound type, the mean savings per surgical procedure from using antimicrobial sutures were significant: £91·25 (90 per cent c.i. 49·62 to 142·76) (€105·09 (57·15 to 164·41); exchange rate 15 November 2016) across all wound types. CONCLUSION The reviewed literature suggested that antimicrobial sutures may result in significant savings across various surgical wound types.
Collapse
Affiliation(s)
- D J Leaper
- Faculty of Medical Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne, and Department of Clinical Sciences, Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
| | - C E Edmiston
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - C E Holy
- Johnson & Johnson Epidemiology and Health Informatics - Medical Devices, New Brunswick, New Jersey, USA
| |
Collapse
|
7
|
McCallum I, O'Loughlin P, Robinson S, Wright LJ, Thomas CLG. Antibiotic-coated sutures versus non-antibiotic-coated sutures for the prevention of abdominal surgical wound infection. Hippokratia 2016. [DOI: 10.1002/14651858.cd011297.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Iain McCallum
- Newcastle upon Tyne Hospitals NHS Foundation Trust; Department of HPB & Transplant Surgery; Freeman Road, High Heaton Newcastle upon Tyne UK NE7 7DN
| | - Paul O'Loughlin
- Queen Elizabeth Hospital; General Surgery; Queen Elizabeth Avenue Sheriff Hill Gateshead Tyne & Wear UK NE9 6SX
| | - Stuart Robinson
- Newcastle upon Tyne Hospitls NHS Foundation Trust; Department of HPB & Transplant Surgery; Freeman Road, High Heaton Newcastle upon Tyne UK NE7 7DN
| | - Lucie J Wright
- Royal Victoria Hospital; Plastic Surgery; Queen Victoria Road Newcastle Tyne and Wear UK NE1 4LP
| | - Christophe LG Thomas
- Newcastle University Trust Hospitals; General Surgery; Queen Victoria Rd Newcastle upon Tyne Tyne and Wear UK NE1 4LP
| |
Collapse
|
8
|
Singh A, Bartsch SM, Muder RR, Lee BY. An Economic Model: Value of Antimicrobial-Coated Sutures to Society, Hospitals, and Third-Party Payers in Preventing Abdominal Surgical Site Infections. Infect Control Hosp Epidemiol 2016; 35:1013-20. [DOI: 10.1086/677163] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundWhile the persistence of high surgical site infection (SSI) rates has prompted the advent of more expensive sutures that are coated with antimicrobial agents to prevent SSIs, the economic value of such sutures has yet to be determined.MethodsUsing TreeAge Pro, we developed a decision analytic model to determine the cost-effectiveness of using antimicrobial sutures in abdominal incisions from the hospital, third-party payer, and societal perspectives. Sensitivity analyses systematically varied the risk of developing an SSI (range, 5%–20%), the cost of triclosan-coated sutures (range, $5–$25/inch), and triclosan-coated suture efficacy in preventing infection (range, 5%–50%) to highlight the range of costs associated with using such sutures.ResultsTriclosan-coated sutures saved $4,109–$13,975 (hospital perspective), $4,133–$14,297 (third-party payer perspective), and $40,127–$53,244 (societal perspective) per SSI prevented, when a surgery had a 15% SSI risk, depending on their efficacy. If the SSI risk was no more than 5% and the efficacy in preventing SSIs was no more than 10%, triclosan-coated sutures resulted in extra expenditure for hospitals and third-party payers (resulting in extra costs of $1,626 and $1,071 per SSI prevented for hospitals and third-party payers, respectively; SSI risk, 5%; efficacy, 10%).ConclusionsOur results suggest that switching to triclosan-coated sutures from the uncoated sutures can both prevent SSIs and save substantial costs for hospitals, third-party payers, and society, as long as efficacy in preventing SSIs is at least 10% and SSI risk is at least 10%.
Collapse
|
9
|
Guo J, Pan LH, Li YX, Yang XD, Li LQ, Zhang CY, Zhong JH. Efficacy of triclosan-coated sutures for reducing risk of surgical site infection in adults: a meta-analysis of randomized clinical trials. J Surg Res 2016; 201:105-17. [PMID: 26850191 DOI: 10.1016/j.jss.2015.10.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 09/19/2015] [Accepted: 10/07/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is the third most frequent type of nosocomial infections. Triclosan-coated sutures are often used to reduce the risk of SSI, but studies examining this have given conflicting results. Therefore, this meta-analysis was performed to assess the efficacy of triclosan-coated sutures for reducing risk of SSI in adults. METHODS PubMed, EMBASE, Google Scholar, and ClinicalTrials.gov were searched to identify randomized clinical trials evaluating triclosan-coated sutures for preventing SSI on patients 18 y or older. RESULTS Thirteen randomized clinical trials involving 5256 participants were included. Triclosan-coated sutures were associated with lower risk of SSI than uncoated sutures across all surgeries (risk ratio [RR] 0.76, 95% confidence interval [CI] 0.65-0.88, P < 0.001). Similar proportions of patients experienced wound dehiscence with either type of suture (RR 0.97, 95% CI 0.49-1.89, P = 0.92). Subgroup analysis showed lower risk of SSI with triclosan-coated sutures in abdominal surgeries (RR 0.70, 95% CI 0.50-0.99, P = 0.04) and group with prophylactic antibiotic (RR 0.79, 95% CI 0.63-0.99, P = 0.04). However, such risk reduction was not observed in cardiac surgeries, breast surgeries, or group without prophylactic antibiotic. CONCLUSIONS Triclosan-coated sutures can decrease the incidence of SSI in abdominal surgeries and might not interfere with wound healing process. Nevertheless, further studies are needed to examine whether triclosan-coated sutures are effective at preventing SSI in non-abdominal surgeries and to further study the interaction of antibiotic prophylaxis with triclosan-coated sutures.
Collapse
Affiliation(s)
- Jiao Guo
- Experimental Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China
| | - Ling-Hui Pan
- Anesthesia Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China
| | - Yun-Xi Li
- Cancer Registry Department, People's Hospital of Fusui County, Fusui, PR China
| | - Xiang-Di Yang
- Experimental Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China
| | - Le-Qun Li
- Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China
| | - Chun-Yan Zhang
- Experimental Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China.
| | - Jian-Hong Zhong
- Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China.
| |
Collapse
|
10
|
Extended versus standard lymphadenectomy in patients undergoing pancreaticoduodenectomy for periampullary adenocarcinoma: a prospective randomized single center trial. Eur Surg 2015. [DOI: 10.1007/s10353-015-0371-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
11
|
Triclosan-coated sutures reduce the risk of surgical site infections: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2015; 36:169-79. [PMID: 25632999 DOI: 10.1017/ice.2014.22] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To analyze available evidence on the effectiveness of triclosan-coated sutures (TCSs) in reducing the risk of surgical site infection (SSI). DESIGN Systematic review and meta-analysis. METHODS A systematic search of both randomized (RCTs) and nonrandomized (non-RCT) studies was performed on PubMed Medline, OVID, EMBASE, and SCOPUS, without restrictions in language and publication type. Random-effects models were utilized and pooled estimates were reported as the relative risk (RR) ratio with 95% confidence interval (CI). Tests for heterogeneity as well as meta-regression, subgroup, and sensitivity analyses were performed. RESULTS A total of 29 studies (22 RCTs, 7 non-RCTs) were included in the meta-analysis. The overall RR of acquiring an SSI was 0.65 (95% CI: 0.55-0.77; I2=42.4%, P=.01) in favor of TCS use. The pooled RR was particularly lower for the abdominal surgery group (RR: 0.56; 95% CI: 0.41-0.77) and was robust to sensitivity analysis. Meta-regression analysis revealed that study design, in part, may explain heterogeneity (P=.03). The pooled RR subgroup meta-analyses for randomized controlled trials (RCTs) and non-RCTs were 0.74 (95% CI: 0.61-0.89) and 0.53 (95% CI: 0.42-0.66), respectively, both of which favored the use of TCSs. CONCLUSION The random-effects meta-analysis based on RCTs suggests that TCSs reduced the risk of SSI by 26% among patients undergoing surgery. This effect was particularly evident among those who underwent abdominal surgery.
Collapse
|
12
|
Triclosan-coated sutures reduce wound infections after spinal surgery: a retrospective, nonrandomized, clinical study. Spine J 2015; 15:933-8. [PMID: 23992939 DOI: 10.1016/j.spinee.2013.06.046] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 05/02/2013] [Accepted: 06/14/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Surgical site infection (SSI) is a serious postoperative complication. The incidence of SSIs is lower in clean orthopedic surgery than in other fields, but it is higher after spinal surgery, reaching 4.15% in high-risk patients. Several studies reported that triclosan-coated polyglactin 910 sutures (Vicryl Plus; Ethicon, Inc., Somerville, NJ, USA) significantly reduced the infection rate in the general surgical, neurosurgical, and thoracic surgical fields. However, there have been no studies on the effects of such coated sutures on the incidence of SSIs in orthopedics. PURPOSE To compare the incidence of wound infections after spinal surgery using triclosan-coated suture materials with that of noncoated ones. STUDY DESIGN/SETTING A retrospective, nonrandomized, and clinical study. PATIENT SAMPLE From May 2010 to April 2012, 405 patients underwent a spinal surgical procedure in the Department of Orthopedic Surgery of two university hospitals. OUTCOME MEASURES The primary outcome was the number of wound infections and dehiscences. METHODS Two hundred five patients had a conventional wound closure with polyglactin 910 suture (Vicryl) between May 2010 and April 2011 (Time Period 1 [TP1]), and 200 patients underwent wound closure with triclosan-coated polyglactin 910 suture (Vicryl Plus) between May 2011 and April 2012 (TP2). Statistical comparisons of wound infections, dehiscence, and risk factors for poor wound healing or infection were performed. None of the authors has any conflict of interest associated with this study. RESULTS There were two cases of wound dehiscence in TP1 and one in TP2 (p=.509). Using noncoated sutures in TP1, eight patients (3.90%) had wound infections, whereas one patient (0.50%) had wound infections in TP2 (using triclosan-coated sutures); the difference was significant (p=.020). CONCLUSIONS The use of triclosan-coated polyglactin 910 sutures instead of polyglactin 910 sutures may reduce the number of wound infections after spinal surgery.
Collapse
|
13
|
Meghil MM, Rueggeberg F, El-Awady A, Miles B, Tay F, Pashley D, Cutler CW. Novel Coating of Surgical Suture Confers Antimicrobial Activity Against Porphyromonas gingivalis and Enterococcus faecalis. J Periodontol 2015; 86:788-94. [PMID: 25703732 DOI: 10.1902/jop.2015.140528] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The oral cavity is colonized by >10(9) bacteria, many of which can increase heart disease risk when seeded into the bloodstream. Most dentoalveolar surgeries require the use of surgical sutures. Suture placement and removal can increase the risk of postoperative infection and bacteremia. The aim of this study is to evaluate the antimicrobial activity of a novel quaternary ammonium compound, K21, when coated on different suture materials. METHODS The periodontal pathogen Porphyromonas gingivalis and the endodontic species Enterococcus faecalis were grown to early log phase and inoculated on enriched Brucella blood agar, on which were placed identical lengths of surgical suture (chromic gut, polyester suture, silk, and nylon suture) and control unwaxed dental floss impregnated with K21 at 5%, 10%, 20%, and 25% volume/volume in ethanol vehicle. Controls included the following: 1) sutures treated with vehicle; 2) untreated sutures; and 3) unwaxed floss. Zones of inhibition in millimeters were measured at five randomized sites per suture/floss for each concentration and material used. Mean ± SD of zones of inhibition were calculated, and analysis of variance (P <0.05) was used to determine whether differences were statistically significant. RESULTS The results indicate that K21-coated suture at concentrations ranging from 5% to 25%, depending on the type of suture, have antimicrobial activity for P. gingivalis and E. faecalis. Nylon suture coated with K21 at 5%, 10%, 20%, and 25% resulted in zones ranging from 3 to 11 mm. Polyester suture was more effective at lower K21 concentrations with 5% (P = 0.0031), 10% (P = 0.0011), and 20% (P = 0.0002), yielding 7.5, 8.3, and 10.5 mm zones of inhibition. K21-coated silk suture yielded significant zones of inhibition at 25% (P <0.0001), whereas chromic gut was effective at K21 concentrations of 5% (P = 0.0081) and 25% (P <0.0001). CONCLUSION It is concluded that K21-coated surgical sutures have antimicrobial activity for bacterial species of direct relevance to postoperative infection and bacteremia.
Collapse
Affiliation(s)
- Mohamed M Meghil
- *Department of Oral Biology, Georgia Regents University, Augusta, GA
| | - Frederick Rueggeberg
- †Division of Infectious Diseases, Anschutz Medical Campus, University of Colorado Denver, Aurora, CO
| | - Ahmed El-Awady
- ‡Department of Oral Rehabilitation, Georgia Regents University
| | - Brodie Miles
- §Department of Periodontics, Georgia Regents University
| | - Franklin Tay
- ‖Department of Endodontics, Georgia Regents University
| | - David Pashley
- *Department of Oral Biology, Georgia Regents University, Augusta, GA
| | | |
Collapse
|
14
|
Jung KH, Oh SJ, Choi KK, Kim SM, Choi MG, Lee JH, Noh JH, Sohn TS, Bae JM, Kim S. Effect of triclosan-coated sutures on surgical site infection after gastric cancer surgery via midline laparotomy. Ann Surg Treat Res 2014; 87:311-8. [PMID: 25485239 PMCID: PMC4255552 DOI: 10.4174/astr.2014.87.6.311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/27/2014] [Accepted: 07/03/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Surgical site infection (SSI) after open abdominal surgery is still a frequently reported nosocomial infection. To reduce the incidence of SSI, triclosan-coated sutures with antiseptic activity (Vicryl Plus) were developed. The aim of this study was to analyze the effect of Vicryl Plus on SSI after gastric cancer surgery via midline laparotomy. METHODS A total of 916 patients who underwent gastric cancer surgery at Samsung Medical Center between December 2009 and September 2011 were prospectively collected. We examined the occurrence of SSI (primary endpoint), assessments of wound healing (secondary endpoint). They were evaluated postoperatively on days 3, 7, and 30. RESULTS Of the 916 patients, 122 were excluded postoperatively by screening (out of the study protocol, adverse events, etc.). The remaining 794 patients were enrolled and monitored postoperatively. The cumulative SSI incidence was 11 cases (1.39%; 95% confidence interval [CI], 0.77-2.50) on day 30. Seromas were most frequently detected in wound healing assessments, with a cumulative incidence of 147 cases (18.51%; 95% CI, 15.98-21.39) on day 30. CONCLUSION The use of triclosan-coated sutures (Vicryl Plus) for abdominal wall closure can reduce the number of SSIs in gastric cancer surgery.
Collapse
Affiliation(s)
- Kuk Hyun Jung
- Department of Surgery, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Seung Jong Oh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kang Kook Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su Mi Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Gew Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Ho Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hyung Noh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Sung Sohn
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Moon Bae
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
15
|
A study of the efficacy of antibacterial sutures for surgical site infection: a retrospective controlled trial. Int Surg 2014; 98:129-32. [PMID: 23701147 DOI: 10.9738/cc179] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To reduce bacterial adherence to surgical sutures, triclosan-coated polyglactin 910 suture materials with antiseptic activity were developed. The aim of this study was to evaluate whether the incidence of surgical site infections can be reduced when triclosan-coated sutures are used. Until December 2009, we used conventional polyglactin 910 sutures (VICRYL, Ethicon) for the closure of the fascia in digestive tract surgery. Therefore, for the control group we retrospectively collected surveillance data for 1.5 years. In the control group, 611 patients underwent digestive tract surgery with VICRYL sutures. Beginning in July 2010, we used triclosan-coated polyglactin 910 sutures (VICRYL Plus, Ethicon, Tokyo, Japan) for the closure of the fascia in all digestive surgeries. So, we collected data for the study group from July 2010 until June 2011. In the study group, 467 patients underwent digestive tract surgery with triclosan-coated VICRYL Plus sutures. In the control group, 75 patients (12.2%) developed wound infections. In the study group, 31 patients (6.6%) developed wound infections, which was significantly lower. Emergency cases; laparoscopic cases, including some cholecystectomy and colectomy cases; American Society of Anesthesiologists classification; the use of immunosuppressive therapy; colostomy cases; wound classification; and suture material were identified as the risk factors for wound infections. In both groups, as the wound classification worsened, the wound infection rate increased. Triclosan-coated polyglactin 910 antimicrobial sutures lead to a significant decrease in the incidence of surgical site infections, especially in clean/contaminated cases.
Collapse
|
16
|
Melt-spun bioactive sutures containing nanohybrids for local delivery of anti-inflammatory drugs. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2014; 43:300-9. [DOI: 10.1016/j.msec.2014.07.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 06/06/2014] [Accepted: 07/02/2014] [Indexed: 11/22/2022]
|
17
|
Diener MK, Knebel P, Kieser M, Schüler P, Schiergens TS, Atanassov V, Neudecker J, Stein E, Thielemann H, Kunz R, von Frankenberg M, Schernikau U, Bunse J, Jansen-Winkeln B, Partecke LI, Prechtl G, Pochhammer J, Bouchard R, Hodina R, Beckurts KTE, Leißner L, Lemmens HP, Kallinowski F, Thomusch O, Seehofer D, Simon T, Hyhlik-Dürr A, Seiler CM, Hackert T, Reissfelder C, Hennig R, Doerr-Harim C, Klose C, Ulrich A, Büchler MW. Effectiveness of triclosan-coated PDS Plus versus uncoated PDS II sutures for prevention of surgical site infection after abdominal wall closure: the randomised controlled PROUD trial. Lancet 2014; 384:142-52. [PMID: 24718270 DOI: 10.1016/s0140-6736(14)60238-5] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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, randomised 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 randomisation tool was used to randomly assign eligible participants by permuted block randomisation 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 randomly 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.
Collapse
Affiliation(s)
- Markus K Diener
- Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany; Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Phillip Knebel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Meinhard Kieser
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Philipp Schüler
- Department of General and Visceral Surgery, University Medical Center, Georg-August-Universität, Göttingen, Germany
| | - Tobias S Schiergens
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Ludwig-Maximilians-Universität Munich, Großhadern Campus, Munich, Germany
| | - Vladimir Atanassov
- Visceral and Vascular Surgery, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Jens Neudecker
- Department of General, Visceral, Vascular and Thoracic Surgery, Campus Charité Mitte, Berlin, Germany
| | - Erwin Stein
- Department of General, Visceral and Trauma Surgery, St Josefs Hospital Dortmund-Hörde, Dortmund, Germany
| | - Henryk Thielemann
- Clinic for General and Visceral Surgery, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Reiner Kunz
- Clinic for General and Visceral Surgery, St Joseph Hospital Berlin Tempelhof, Berlin, Germany
| | - Moritz von Frankenberg
- Department of General, Abdominal and Minimal Invasive Surgery, Krankenhaus Salem, Department of Surgery, Heidelberg, Germany
| | - Utz Schernikau
- Department of General, Visceral and Minimal Invasive Surgery, Park-Klinik Weißensee, Berlin, Germany
| | - Jörg Bunse
- Department of General and Visceral Surgery, Sana Klinikum Lichtenberg, Berlin, Germany
| | - Boris Jansen-Winkeln
- Clinic for General, Visceral and Transplantation Surgery, Universitätsmedizin Mainz, Mainz, Germany
| | - Lars I Partecke
- Department for General, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Gerald Prechtl
- Clinic for Surgery, Kliniken des Landkreises Neumarkt i. d. Oberpfalz, Neumarkt, Germany
| | - Julius Pochhammer
- Clinic for General, Visceral and Thoracic Surgery, Marienhospital Stuttgart, Stuttgart, Germany
| | - Ralf Bouchard
- Clinic for Surgery, University Clinic Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - René Hodina
- Clinic for General, Visceral and Thorax Surgery, Klinikum am Steinenberg Reutlingen, Reutlingen, Germany
| | - K Tobias E Beckurts
- Department for General, Visceral and Trauma Surgery, Krankenhaus der Augustinerinnen, Cologne, Germany
| | - Lothar Leißner
- Clinic for General, Visceral, Thoracic, Transplantation and Pediatric Surgery Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Hans-Peter Lemmens
- Department of Surgery, Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Friedrich Kallinowski
- Department of General and Visceral Surgery, Asklepios Klinik Harburg, Hamburg, Germany
| | - Oliver Thomusch
- Department of General and Visceral Surgery, Albert-Ludwig University, Freiburg, Germany
| | - Daniel Seehofer
- Department of General, Visceral and Transplantation Surgery, Charité Campus Virchow Klinikum, Berlin, Germany
| | - Thomas Simon
- Department of General and Visceral Surgery, GRN Klinik Sinsheim, Sinsheim, Germany
| | - Alexander Hyhlik-Dürr
- Department of Vascular and Endovascular Surgery, University of Heidelberg, Heidelberg, Germany
| | - Christoph M Seiler
- Department of General, Visceral and Vascular Surgery, Josephs-Hospital Warendorf, Germany
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Christoph Reissfelder
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - René Hennig
- Department of General and Visceral Surgery, Katharinenhospital, Stuttgart, Germany
| | - Colette Doerr-Harim
- Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany
| | - Christina Klose
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Alexis Ulrich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
| |
Collapse
|
18
|
Obermeier A, Schneider J, Wehner S, Matl FD, Schieker M, von Eisenhart-Rothe R, Stemberger A, Burgkart R. Novel high efficient coatings for anti-microbial surgical sutures using chlorhexidine in fatty acid slow-release carrier systems. PLoS One 2014; 9:e101426. [PMID: 24983633 PMCID: PMC4077814 DOI: 10.1371/journal.pone.0101426] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 06/05/2014] [Indexed: 11/19/2022] Open
Abstract
Sutures can cause challenging surgical site infections, due to capillary effects resulting in bacteria permeating wounds. Anti-microbial sutures may avoid these complications by inhibiting bacterial pathogens. Recently, first triclosan-resistances were reported and therefore alternative substances are becoming clinically relevant. As triclosan alternative chlorhexidine, the “gold standard” in oral antiseptics was used. The aim of the study was to optimize novel slow release chlorhexidine coatings based on fatty acids in surgical sutures, to reach a high anti-microbial efficacy and simultaneously high biocompatibility. Sutures were coated with chlorhexidine laurate and chlorhexidine palmitate solutions leading to 11, 22 or 33 µg/cm drug concentration per length. Drug release profiles were determined in aqueous elutions. Antibacterial efficacy against Staphylococcus aureus was assessed in agar diffusion tests. Biocompatibility was evaluated via established cytotoxicity assay (WST-1). A commercially triclosan-containing suture (Vicryl Plus), was used as anti-microbial reference. All coated sutures fulfilled European Pharmacopoeia required tensile strength and proved continuous slow drug release over 96 hours without complete wash out of the coated drug. High anti-microbial efficacy for up to 5 days was observed. Regarding biocompatibility, sutures using 11 µg/cm drug content displayed acceptable cytotoxic levels according to ISO 10993-5. The highest potential for human application were shown by the 11 µg/cm chlorhexidine coated sutures with palmitic acid. These novel coated sutures might be alternatives to already established anti-microbial sutures such as Vicryl Plus in case of triclosan-resistance. Chlorhexidine is already an established oral antiseptic, safety and efficacy should be proven for clinical applications in anti-microbial sutures.
Collapse
Affiliation(s)
- Andreas Obermeier
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Bavaria, Germany
- * E-mail:
| | - Jochen Schneider
- Institut für Mikrobiologie, Immunologie und Hygiene, Klinikum rechts der Isar, Technische Universität München, München, Bavaria, Germany
| | - Steffen Wehner
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Bavaria, Germany
| | - Florian Dominik Matl
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Bavaria, Germany
| | - Matthias Schieker
- Experimentelle Chirurgie und Regenerative Medizin, Klinik für Chirurgie, Klinikum der Universität München, München, Bavaria, Germany
| | - Rüdiger von Eisenhart-Rothe
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Bavaria, Germany
| | - Axel Stemberger
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Bavaria, Germany
| | - Rainer Burgkart
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Bavaria, Germany
| |
Collapse
|
19
|
Okada N, Nakamura T, Ambo Y, Takada M, Nakamura F, Kishida A, Kashimura N. Triclosan-Coated Abdominal Closure Sutures Reduce the Incidence of Surgical Site Infections after Pancreaticoduodenectomy. Surg Infect (Larchmt) 2014; 15:305-9. [DOI: 10.1089/sur.2012.170] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Naoya Okada
- Department of Surgery, Teine-Keijinkai Hospital, Teine-ku, Sapporo, Japan
| | - Toru Nakamura
- Department of Surgery, Teine-Keijinkai Hospital, Teine-ku, Sapporo, Japan
| | - Yoshiyasu Ambo
- Department of Surgery, Teine-Keijinkai Hospital, Teine-ku, Sapporo, Japan
| | - Minoru Takada
- Department of Surgery, Teine-Keijinkai Hospital, Teine-ku, Sapporo, Japan
| | - Fumitaka Nakamura
- Department of Surgery, Teine-Keijinkai Hospital, Teine-ku, Sapporo, Japan
| | - Akihiro Kishida
- Department of Surgery, Teine-Keijinkai Hospital, Teine-ku, Sapporo, Japan
| | - Nobuichi Kashimura
- Department of Surgery, Teine-Keijinkai Hospital, Teine-ku, Sapporo, Japan
| |
Collapse
|
20
|
Kathju S, Nistico L, Tower I, Lasko LA, Stoodley P. Bacterial biofilms on implanted suture material are a cause of surgical site infection. Surg Infect (Larchmt) 2014; 15:592-600. [PMID: 24833403 DOI: 10.1089/sur.2013.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Surgical site infection (SSI) has been estimated to occur in up to 5% of all procedures, accounting for up to 0.5% of all hospital costs. Bacterial biofilms residing on implanted foreign bodies have been implicated as contributing or causative factors in a wide variety of infectious scenarios, but little consideration has been given to the potential for implanted, submerged suture material to act as a host for biofilm and thus serve as a nidus of infection. METHODS We report a series of 15 patients who underwent open Roux-en-Y gastric bypass (with musculofascial closure with permanent, multifilament sutures) who developed longstanding and refractory SSIs in the abdominal wall. Explanted suture material at subsequent exploration was examined for biofilm with confocal laser-scanning microscopy (CLSM) and fluorescence in situ hybridization (FISH). RESULTS All 15 patients at re-exploration were found to have gross evidence of a "slimy" matrix or dense reactive granulation tissue localized to the implanted sutures. Confocal laser-scanning microscopy revealed abundant biofilm present on all sutures examined; FISH was able to identify the presence of specific pathogens in the biofilm. Complete removal of the foreign bodies (and attendant biofilms) resulted in all cases in cure of the SSI. CONCLUSION Bacterial biofilms on implanted suture material can manifest as persistent surgical site infections that require complete removal of the underlying foreign body substrata for resolution.
Collapse
Affiliation(s)
- Sandeep Kathju
- 1 Department of Plastic Surgery, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
| | | | | | | | | |
Collapse
|
21
|
Zhang S, Liu X, Wang H, Peng J, Wong KKY. Silver nanoparticle-coated suture effectively reduces inflammation and improves mechanical strength at intestinal anastomosis in mice. J Pediatr Surg 2014; 49:606-13. [PMID: 24726122 DOI: 10.1016/j.jpedsurg.2013.12.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 12/11/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Our previous studies have revealed that silver nanoparticles (AgNPs) had anti-inflammatory properties. In this study, we coated AgNPs onto the surface of absorbable suture, to further explore their anti-inflammatory efficacy and potential clinical application using an intestinal anastomosis model. METHODS Layer-by-layer deposition was used to coat AgNPs on absorbable sutures. Scanning electron microscopy (SEM) was conducted to observe the morphology and distribution of AgNPs on suture surface. 1cm of either non-coated suture, suture coated with antibiotics or AgNPs-coated suture was placed on E. coli overlay of LB agar plates to test for bacterial inhibition. The respective sutures were then used for ileal anastomosis in mice. The anastomotic sites were harvested to investigate the degree of tissue inflammation and cell proliferation, as well as collagen deposition. Furthermore, burst pressure measurement was employed to test for mechanical properties. RESULTS SEM observation indicated AgNPs could be immobilized and distributed on suture surface evenly. AgNPs-coated suture had the best in vitro anti-bacterial efficacy when compared with other groups. Subsequent immunohistochemistry in the intestinal anastomosis model showed significantly less inflammatory cell infiltration (macrophage and neutrophil) and better collagen deposition in the anastomotic tissue in the AgNPs-coated suture group. Burst pressure measurement in healed anastomosis further confirmed that AgNPs-coated suture had better mechanical properties. CONCLUSION Our study suggests that AgNPs-coated sutures can improve anastomosis healing due to better mechanical properties from reduced inflammation.
Collapse
Affiliation(s)
- Shiwei Zhang
- Department of Surgery, Harbin Children hospital, Harbin, China
| | - Xuelai Liu
- Department of Surgery, Li Ka Shing Faculty of Medicine, The university of Hong Kong, Hong Kong, China
| | - Hualong Wang
- Department of Surgery, Changchun Children Hospital, Changchun, China
| | - Jiao Peng
- Department of Surgery, Harbin Children hospital, Harbin, China
| | - Kenneth K Y Wong
- Department of Surgery, Li Ka Shing Faculty of Medicine, The university of Hong Kong, Hong Kong, China.
| |
Collapse
|
22
|
Edmiston CE, Daoud FC, Leaper D. Is there an evidence-based argument for embracing an antimicrobial (triclosan)-coated suture technology to reduce the risk for surgical-site infections?: A meta-analysis. Surgery 2013; 154:89-100. [PMID: 23809487 DOI: 10.1016/j.surg.2013.03.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 03/25/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND It has been estimated that 750,000 to 1 million surgical-site infections (SSIs) occur in the United States each year, causing substantial morbidity and mortality. Triclosan-coated sutures were developed as an adjunctive strategy for SSI risk reduction, but a recently published systematic literature review and meta-analysis suggested that no clinical benefit is associated with this technology. However, that study was hampered by poor selection of available randomized controlled trials (RCTs) and low patient numbers. The current systematic review involves 13 randomized, international RCTs, totaling 3,568 surgical patients. METHODS A systematic literature search was performed on PubMed, Embase/Medline, Cochrane database group (Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Health Economic Evaluations Database/Database of Health Technology Assessments), and www.clinicaltrials.gov to identify RCTs of triclosan-coated sutures compared with conventional sutures and assessing the clinical effectiveness of antimicrobial sutures to decrease the risk for SSIs. A fixed- and random-effects model was developed, and pooled estimates reported as risk ratio (RR) with a corresponding 95% confidence interval (CI). Publication bias was assessed by analyzing a funnel plot of individual studies and testing the Egger regression intercept. RESULTS The meta-analysis (13 RCTs, 3,568 patients) found that use of triclosan antimicrobial-coated sutures was associated with a decrease in SSIs in selected patient populations (fixed effect: RR = 0.734; 95% CI: 0.590-0.913; P = .005; random-effect: RR = 0.693; 95% CI: 0.533-0.920; P = .011). No publication bias was detected (Egger intercept test: P = .145). CONCLUSION Decreasing the risk for SSIs requires a multifaceted "care bundle" approach, and this meta-analysis of current, pooled, peer-reviewed, randomized controlled trials suggests a clinical effectiveness of antimicrobial-coated sutures (triclosan) in the prevention of SSIs, representing Center for Evidence-Based Medicine level 1a evidence.
Collapse
Affiliation(s)
- Charles E Edmiston
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
| | | | | |
Collapse
|
23
|
Itatsu K, Sugawara G, Kaneoka Y, Kato T, Takeuchi E, Kanai M, Hasegawa H, Arai T, Yokoyama Y, Nagino M. Risk factors for incisional surgical site infections in elective surgery for colorectal cancer: focus on intraoperative meticulous wound management. Surg Today 2013; 44:1242-52. [DOI: 10.1007/s00595-013-0677-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 06/14/2013] [Indexed: 12/12/2022]
|
24
|
Surgical-site infection after abdominal wall closure with triclosan-impregnated polydioxanone sutures: results of a randomized clinical pathway facilitated trial (NCT00998907). Surgery 2013; 154:589-95. [PMID: 23859304 DOI: 10.1016/j.surg.2013.04.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 04/03/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Wound infections after abdominal surgery are still frequent types of nosocomial infections. Suture materials might serve as a vehicle for mechanical transport of bacteria into the surgical wound. To prevent the contamination of suture material in surgical wounds, triclosan-coated suture materials with antibacterial activity was developed. We here report a prospective randomized pathway controlled trial investigating the effect of triclosan impregnation of polydioxanone sutures used for abdominal wall closure on the rate of surgical-site infections. PATIENTS AND METHODS A total of 856 patients included in this trial underwent a standardized clinical pathway documented abdominal wall closure after abdominal surgery. Patients were randomized to have the fascia closed with either a 2-0 polydioxanone loop or a triclosan impregnated 2-0 polydioxanone loop. The primary outcome was the number of wound infections. Risk factors for poor wound healing were collected prospectively to compare the two groups. RESULTS When a PDS loop suture for abdominal wall closure was used, 42 (11.3%) patients with wound infections were detected. The number of patients with wound infections decreased significantly to 31 when the PDS plus for abdominal wall closure was used (6.4%, P < .05). Other risk factors for the development of side infections were comparably in the two groups. CONCLUSION This clinical pathway facilitated trial shows that triclosan impregnation of a 2-0 polydioxanone closing suture can decrease wound infections in patients having a laparotomy for general and abdominal vascular procedures.
Collapse
|
25
|
Thimour-Bergström L, Roman-Emanuel C, Scherstén H, Friberg Ö, Gudbjartsson T, Jeppsson A. Triclosan-coated sutures reduce surgical site infection after open vein harvesting in coronary artery bypass grafting patients: a randomized controlled trial. Eur J Cardiothorac Surg 2013; 44:931-8. [PMID: 23435526 PMCID: PMC3794438 DOI: 10.1093/ejcts/ezt063] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The incidence of surgical site infection (SSI) after open vein harvesting in coronary artery bypass grafting (CABG) patients ranges in different studies between 2 and 20%. Triclosan is an antibacterial substance that reduces the growth of bacteria by inhibiting fatty acid synthesis. We hypothesized that wound closure with triclosan-coated sutures would reduce SSI after open vein harvesting. METHODS An investigator-initiated prospective randomized double-blind single-centre study was performed with 374 patients, randomized to subcutaneous and intracutaneous leg-wound closure with either triclosan-coated sutures (Vicryl Plus and Monocryl Plus, Ethicon, Somerville, NJ, USA) (n = 184) or identical sutures without triclosan (n = 190) from the same manufacturer. All patients were followed up after 30 days (clinical visit) and 60 days (telephone interview). Primary endpoint was SSI within 60 days after surgery according to the definition of Center for Disease Control. Predefined secondary endpoints included culture-proven and antibiotic-treated SSI. RESULTS The primary endpoint occurred in 23 patients (12.5%) with triclosan-coated sutures and in 38 patients (20.0%) in the group without triclosan (P = 0.0497, risk ratio 0.63, (95% confidence interval 0.39-1.00). Corresponding figures for culture-proven infections were 7.6 vs 12.1%, (P = 0.15), and for antibiotic-treated infections, 10.9 vs 18.4%, (P = 0.039). Staphylococcus aureus and coagulase-negative staphylococci were the most common pathogens in both groups. Insulin-treated diabetes and vein-harvesting time were associated with SSI after vein harvesting. CONCLUSIONS Leg-wound closure with triclosan-coated sutures in CABG patients reduces SSIs after open vein harvesting. (ClinicalTrials.gov number NCT01212315).
Collapse
|
26
|
Wang ZX, Jiang CP, Cao Y, Ding YT. Systematic review and meta-analysis of triclosan-coated sutures for the prevention of surgical-site infection. Br J Surg 2013; 100:465-73. [PMID: 23338685 DOI: 10.1002/bjs.9062] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2012] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Surgical-site infections (SSIs) increase morbidity and mortality in surgical patients and represent an economic burden to healthcare systems. Experiments have shown that triclosan-coated sutures (TCS) are beneficial in the prevention of SSI, although the results from individual randomized controlled trials (RCTs) are inconclusive. A meta-analysis of available RCTs was performed to evaluate the efficacy of TCS in the prevention of SSI.
Methods
A systematic search of PubMed, Embase, MEDLINE, Web of Science®, the Cochrane Central Register of Controlled Trials and internet-based trial registries for RCTs comparing the effect of TCS and conventional uncoated sutures on SSIs was conducted until June 2012. The primary outcome investigated was the incidence of SSI. Pooled relative risks with 95 per cent confidence interval (c.i.) were estimated with RevMan 5.1.6.
Results
Seventeen RCTs involving 3720 participants were included. No heterogeneity of statistical significance across studies was observed. TCS showed a significant advantage in reducing the rate of SSI by 30 per cent (relative risk 0·70, 95 per cent c.i. 0·57 to 0·85; P < 0·001). Subgroup analyses revealed consistent results in favour of TCS in adult patients, abdominal procedures, and clean or clean-contaminated surgical wounds.
Conclusion
TCS demonstrated a significant beneficial effect in the prevention of SSI after surgery.
Collapse
Affiliation(s)
- Z X Wang
- Department of Hepatobiliary Surgery, Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
- Jiangsu Province's Key Medical Centre for Liver Surgery, Nanjing, Jiangsu Province, China
| | - C P Jiang
- Department of Hepatobiliary Surgery, Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
- Jiangsu Province's Key Medical Centre for Liver Surgery, Nanjing, Jiangsu Province, China
| | - Y Cao
- Department of Hepatobiliary Surgery, Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
- Jiangsu Province's Key Medical Centre for Liver Surgery, Nanjing, Jiangsu Province, China
| | - Y T Ding
- Department of Hepatobiliary Surgery, Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
- Jiangsu Province's Key Medical Centre for Liver Surgery, Nanjing, Jiangsu Province, China
| |
Collapse
|
27
|
Nakamura T, Kashimura N, Noji T, Suzuki O, Ambo Y, Nakamura F, Kishida A. Triclosan-coated sutures reduce the incidence of wound infections and the costs after colorectal surgery: a randomized controlled trial. Surgery 2012; 153:576-83. [PMID: 23261025 DOI: 10.1016/j.surg.2012.11.018] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 11/16/2012] [Indexed: 01/04/2023]
Abstract
BACKGROUND In colorectal surgeries, surgical site infections (SSIs) frequently cause morbidity; an incidence of up to 20% has been shown in previous studies. Recently, to prevent microbial colonization of suture material in operative wounds, triclosan-coated polyglactin suture materials with antimicrobial activity have been developed; however, their significance in colorectal surgery remains unclear. This randomized controlled trial was conducted to assess the value of triclosan-coated polyglactin sutures in colorectal surgery. METHODS A total of 410 consecutive patients who had undergone elective colorectal operations were enrolled in this trial. Of those patients, the 206 in the study group underwent wound closure with triclosan-coated polyglactin 910 antimicrobial sutures, and the 204 patients in the control group received conventional wound closures with polyglactin 910 sutures. RESULTS The study group and the control group were comparable regarding risk factors for SSIs. The incidence of wound infection in the study group was 9 of 206 patients (4.3%), and that in the control group was 19 of 204 patients (9.3%). The difference is statistically significant in the 2 groups (P = .047). The median additional cost of wound infection management was $2,310. The actual entire additional cost, therefore, of 9 patients in the study group was $18,370, and that of 19 patients in the control group was $60,814. CONCLUSION Triclosan-coated sutures can reduce the incidence of wound infections and the costs in colorectal surgery.
Collapse
Affiliation(s)
- Toru Nakamura
- Department of Surgery, Teine-Keijinkai Hospital, Teine-ku, Sapporo, Japan.
| | | | | | | | | | | | | |
Collapse
|
28
|
Prevention of abdominal wound infection (PROUD trial, DRKS00000390): study protocol for a randomized controlled trial. Trials 2011; 12:245. [PMID: 22103965 PMCID: PMC3250941 DOI: 10.1186/1745-6215-12-245] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 11/21/2011] [Indexed: 11/23/2022] Open
Abstract
Background Wound infection affects a considerable portion of patients after abdominal operations, increasing health care costs and postoperative morbidity and affecting quality of life. Antibacterial coating has been suggested as an effective measure to decrease postoperative wound infections after laparotomies. The INLINE metaanalysis has recently shown the superiority of a slowly absorbable continuous suture for abdominal closure; with PDS plus® such a suture has now been made available with triclosan antibacterial coating. Methods/Design The PROUD trial is designed as a randomised, controlled, observer, surgeon and patient blinded multicenter superiority trial with two parallel groups and a primary endpoint of wound infection during 30 days after surgery. The intervention group will receive triclosan coated polydioxanone sutures, whereas the control group will receive the standard polydioxanone sutures; abdominal closure will otherwise be standardized in both groups. Statistical analysis is based on intention-to-treat population via binary logistic regression analysis, the total sample size of n = 750 is sufficient to ensure alpha = 5% and power = 80%, an interim analysis will be carried out after data of 375 patients are available. Discussion The PROUD trial will yield robust data to determine the effectiveness of antibacterial coating in one of the standard sutures for abdominal closure and potentially lead to amendment of current guidelines. The exploration of clinically objective parameters as well as quality of life holds immediate relevance for clinical management and the pragmatic trial design ensures high external validity. Trial Registration The trial protocol has been registered with the German Clinical Trials Register (DRKS00000390).
Collapse
|
29
|
Justinger C, Slotta JE, Schilling MK. Incisional hernia after abdominal closure with slowly absorbable versus fast absorbable, antibacterial-coated sutures. Surgery 2011; 151:398-403. [PMID: 22088813 DOI: 10.1016/j.surg.2011.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 08/04/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Incisional hernia remains among the most common complications after midline incision of the abdominal wall. The role of the suture material used for abdominal wall closure remains controversial. To decrease bacterial adherence to surgical sutures, braided suture materials with antibacterial activity (Vicryl plus, Ethicon, Inc) were developed. This is the first study to analyze long-term results using an antibacterial-braided suture material for abdominal wall closure in a large clinical trial. METHODS To analyze the effects of Triclosan-coated suture material (Vicryl plus) on the development of incisional hernia, we performed a 36-month follow-up of 1,018 patients who had a primary midline incision for elective abdominal surgery. In the first time period, a PDS II loop suture was used. In the second observation period, we used Vicryl plus. All variables were recorded prospectively in a database. The primary outcome was the number of incisional hernias. Risk factors for the development of incisional hernias were collected prospectively to compare the 2 groups. RESULTS The overall incisional hernia rate in the 36-month follow-up period was 14.6%. Analyzing the influence of the suture material used on the development of incisional hernia, we did not find differences between the 2 groups (PDS II, 14%; Vicryl plus, 15.2%). In the multivariate analysis of possible factors in the study population, only body mass index (BMI) showed a significant influence on the development of incisional hernias. Despite the incidence of wound infections being less in the Vicryl plus group (6.1% vs 11.9%; P < .05), there were no difference in incidence of incisional hernia between the 2 groups. CONCLUSION Fast absorbable sutures with antibacterial coating (Tricosan) do not increase the hernia rate after midline abdominal incision compared with slowly absorbable sutures, when wound infection rates are decreased by coating the fast absorbable suture with Triclosan. The development of incisional hernia is significantly increasing in patients with a BMI >30 kg/m(2).
Collapse
Affiliation(s)
- Christoph Justinger
- Department of General, Visceral, Vascular and Paediatric Surgery, University of the Saarland, Homburg/Saar, Germany
| | | | | |
Collapse
|