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Yang Y, Zhou Z, Ma R, Ren J, Wu X. Antimicrobial-coated sutures versus non-coated sutures in reducing surgical site infection: an updated systematic review and meta-analysis. J Hosp Infect 2024; 150:40-50. [PMID: 38823643 DOI: 10.1016/j.jhin.2024.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/13/2024] [Accepted: 04/01/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Antimicrobial-coated sutures are one of the strategies to avoid surgical site infection (SSI) caused by microbial colonization on the surface of surgical sutures. AIM To investigate the effectiveness of antimicrobial-coated sutures in reducing SSI and develop the latest systematic evaluation evidence for clinical SSI prevention and the use of antimicrobial-coated sutures. METHODS The databases of MEDLINE, Embase, CINAHL, Cochrane, African Index Medicus, and WHO Global Health were searched from October 10th, 1990 to March 3rd, 2023 with language restricted to English, Spanish, and French. Meta-analysis was used to evaluate the impact of antimicrobial-coated sutures on SSI and whether their effectiveness is influenced by the type of sutures or wounds. Subgroup analyses were conducted based on type of sutures and wounds. Finally, quality of the retrieved evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). FINDINGS Twenty-six randomized control trials (RCTs) and nine observational studies (OBSs) met the inclusion criteria. Antimicrobial sutures significantly reduced SSI risk (RCTs: odds ratio: 0.74; 95% confidence interval: 0.63-0.87; P = 0.0002; OBSs: OR: 0.61; 95% CI: 0.48-0.76; P < 0.0001). Only subgroup analysis of Polydioxanone Suture (PDS) Plus vs PDS, Vicryl Plus vs Vicryl and mixed wounds revealed consistent results in favour of antimicrobial-coated sutures. According to GRADE, the quality of RCT evidence is moderate, while that of OBS evidence is low. CONCLUSION Antimicrobial-coated sutures are effective in reducing the risk of postoperative SSI among a large number of surgical patients. However, the available evidence is of moderate/low quality and many studies had conflicts of interest.
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Affiliation(s)
- Y Yang
- School of Medicine, Southeast University, Nanjing, China; Research Institute of General Surgery, Jinling Hospital, Nanjing, China
| | - Z Zhou
- Research Institute of General Surgery, Jinling Hospital Nanjing Medical University, Nanjing, China
| | - R Ma
- School of Medicine, Southeast University, Nanjing, China; Research Institute of General Surgery, Jinling Hospital, Nanjing, China
| | - J Ren
- School of Medicine, Southeast University, Nanjing, China; Research Institute of General Surgery, Jinling Hospital, Nanjing, China.
| | - X Wu
- School of Medicine, Southeast University, Nanjing, China; Research Institute of General Surgery, Jinling Hospital, Nanjing, China.
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Unosson H, Nyman MH, Brynhildsen KF, Friberg Ö. Risk factors for infection at the saphenous vein harvest site after coronary artery bypass grafting surgery: a retrospective cohort study. J Cardiothorac Surg 2024; 19:310. [PMID: 38822404 PMCID: PMC11141009 DOI: 10.1186/s13019-024-02799-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/25/2024] [Indexed: 06/03/2024] Open
Abstract
INTRODUCTION Surgical site infection after saphenous vein harvest is common, with reported leg wound infection rates ranging from 2 to 24%. There have been few investigations into sex-related differences in complication rates. Moreover, varied effects of smoking have been reported. The aim of this study was to investigate risk factors such as gender and smoking, associated with surgical site infection after vein graft harvesting in coronary artery bypass grafting surgery. METHODS We included 2,188 consecutive patients who underwent coronary artery bypass grafting surgery with at least one vein graft at our centre from 2009 to 2018. All patients were followed up postoperatively. Risk factors for leg wound infection requiring antibiotic treatment and surgical revision were analysed using logistic regression analysis. RESULTS In total, 374 patients (17.1%) received antibiotic treatment and 154 (7.0%) underwent surgical revision for leg wound infection at the harvest site. Female sex, high body mass index, diabetes mellitus, longer operation time, peripheral vascular disease and direct oral anticoagulants were independently associated with any leg wound infection at the harvest site. Among surgically revised patients, female sex and insulin or oral treatment for diabetes mellitus as well as longer operation time were independent risk factors. Smoking was not associated with leg wound infection. CONCLUSION Female sex is associated with increased risk of leg wound infection. The underlying mechanism is unknown. In the current population, previous or current smoking was not associated with an increased risk of leg wound infection.
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Affiliation(s)
- Hanna Unosson
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
| | - Maria Hälleberg Nyman
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Karin Falk Brynhildsen
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Örjan Friberg
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Edwards M, Graziadio S, Shore J, Schmitz ND, Galvain T, Danker WA, Kocaman M, Pournaras DJ, Bowley DM, Hardy KJ. Plus Sutures for preventing surgical site infection: a systematic review of clinical outcomes with economic and environmental models. BMC Surg 2023; 23:300. [PMID: 37789307 PMCID: PMC10548560 DOI: 10.1186/s12893-023-02187-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 09/07/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Surgical site infections (SSIs) represent ~ 20% of all hospital-acquired infections in surgical patients and are associated with prolonged hospital stay, admission to intensive care, and mortality. We conducted a systematic review with economic and environmental models to assess whether triclosan-coated sutures (Plus Sutures) provide benefits over non-coated sutures in the reduction of SSI risk. METHODS Searches were conducted in fifteen databases. A total of 1,991 records were retrieved. Following deduplication and screening by two independent reviewers, 31 randomized controlled trials in adults and children were included in the review. Similarity of the studies was assessed by narrative review and confirmed by quantitative assessment. A fixed effects meta-analysis of SSI incidence model including all groups of patients estimated a risk ratio of 0.71 (95% confidence interval: 0.64 to 0.79) indicating those in the Plus Sutures group had a 29% reduction in the risk of developing an SSI compared with those in the control group (p < 0.001). Safety outcomes were analysed qualitatively. RESULTS The economic model estimated the use of Plus Sutures to result in average cost savings of £13.63 per patient. Plus Sutures remained cost-saving in all subgroup analyses with cost-savings ranging between £11 (clean wounds) and £140 (non-clean wounds). The environmental impact of SSI is substantial, and the model suggests that the introduction of Plus Sutures could result in potential environmental benefits. CONCLUSIONS The evidence suggests that Plus Sutures are associated with a reduced incidence of SSI across all surgery types alongside cost savings when compared with standard sutures.
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Affiliation(s)
- M Edwards
- York Health Economics Consortium, University of York, Enterprise House, Innovation Way, York, YO10 5NQ, UK.
| | - S Graziadio
- York Health Economics Consortium, University of York, Enterprise House, Innovation Way, York, YO10 5NQ, UK
| | - J Shore
- York Health Economics Consortium, University of York, Enterprise House, Innovation Way, York, YO10 5NQ, UK
| | - N D Schmitz
- Johnson & Johnson MEDICAL GmbH, Robert-Koch-Strasse 1, 22851, Norderstedt, Germany
| | - T Galvain
- Global Health Economics, Johnson & Johnson Medical Devices, New Brunswick, NJ, USA
| | - W A Danker
- Ethicon Inc., 1000 US-202, Raritan, NJ, 08869, USA
| | - M Kocaman
- Johnson & Johnson Medical Limited, Berkshire, UK
| | - D J Pournaras
- Department of Bariatric and Metabolic Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - D M Bowley
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
| | - K J Hardy
- Derbyshire Pathology, University Hospitals Derby and Burton NHS Trust, Royal Derby Hospital, Derby, UK
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Kang H, Lee WK, Choi S, Lee WS. Can Triclosan-Coated Sutures Reduce the Incidence of Surgical Site Infections and Intra-Abdominal Infection: A Double-Blinded Randomized Controlled Trial. Surg Infect (Larchmt) 2023; 24:351-357. [PMID: 36946790 DOI: 10.1089/sur.2022.209] [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: 03/23/2023] Open
Abstract
Abstract Background: Surgical site infections (SSIs) are the most common nosocomial infections suffered by surgical patients. They increase medical costs and prolong hospital stay. With respect to gastrointestinal surgery, SSIs are reported to have an incidence of up to 30%, and they frequently cause morbidity. The aim of this study was to prospectively investigate whether use of triclosan-coated sutures for abdominal incision closure during colorectal surgery reduces the incidence of SSI. Patients and Methods: This was a double-blinded randomized controlled trial in a single academic surgical hospital. Patients who underwent laparoscopic or open colorectal surgery were included. Patients were pre-operatively randomly assigned to either the Vicryl® Plus (VP) or Vicryl® (Ethicon Inc., Somerville, NJ) group. The patients and medical staff were blinded. Results: The primary end point was overall SSI rate and SSI at 30 days. Over a six-year period, 811 patients who underwent colorectal surgery and provided informed consent were randomly assigned (VP group, 396 patients; Vicryl group, 415 patients). No differences in baseline demographics were observed between the groups. The overall incidence of SSI was 4.8% (39/811 patients). There were no statistically significant differences in mean length of post-operative hospital stay between the groups (VP group, 9.3 days; Vicryl group, 9.6 days; p = 0.587). Statistically significant differences in SSI rate after post-operative day 30 were observed between the groups (VP group, 1 patient [7.1%]; Vicryl group, 7 patients [28.0%]; p = 0.039). Conclusions: Although use of triclosan-coated sutures did not reduce incidence of SSI within 30 days post-operatively, it is associated with reduced SSI rate after post-operative day 30.
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Affiliation(s)
- Hari Kang
- Department of Surgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Woon Kee Lee
- Department of Surgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Sangtae Choi
- Department of Surgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Won-Suk Lee
- Department of Surgery, Gil Medical Center, Gachon University, Incheon, Korea
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Larsson H, Nyman MH, Brynhildsen KF. Patients' experiences regarding severe leg wound infection associated with coronary artery bypass grafting: A qualitative study. JOURNAL OF VASCULAR NURSING 2023; 41:12-18. [PMID: 36898799 DOI: 10.1016/j.jvn.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 09/15/2022] [Accepted: 12/19/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Coronary artery bypass grafting (CABG) is the most common cardiac surgery throughout the world. The most commonly used graft is the saphenous vein. Wound healing complications related to saphenous vein harvesting are common, with reported surgical site infection rates ranging from 2% to 20%. Surgical site infection can be long-lasting, and the wound healing can be difficult and also presumably troublesome for the patient. CABG patients' experiences of severe infection in the harvesting site have not been studied before. AIM The aim of this study was to describe patients' experiences associated with acquiring a severe infection in the harvesting site after CABG. METHOD A qualitative study with descriptive design was conducted at the department of vascular and cardiothoracic surgery in a Swedish university hospital from May to December 2018. Patients diagnosed with a severe surgical site infection in the harvesting site following CABG were included. Data from 16 face-to-face interviews were analysed with inductive qualitative content analysis. RESULT The main category, varying impact on body and mind, was the core of the patients' experiences of severe wound infection in the harvesting site after CABG. Two generic categories were identified: physical impact and thoughts about the complication. The patients described experiencing different degrees of pain, anxiety, and limitation in daily life. CONCLUSION These findings indicate that a severe infection in the harvesting site after CABG was experienced as an important issue with varying impact. Overall, the participants experienced pain, anxiety, and limitations in daily life. However, most of them were satisfied with the outcome after the wound had healed. Patients should be advised to seek care at an early stage if symptoms of infection occur. Improved individual pain management is needed for those with severe pain, and varied experiences imply a need for person-centred care.
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Affiliation(s)
- Hanna Larsson
- Department of Vascular and Cardiothoracic Surgery, Örebro University Hospital, SE-701 85 Örebro, Sweden; Faculty of Medicine and Health, School of Health Sciences, Örebro University, SE-701 82 Örebro, Sweden.
| | - Maria Hälleberg Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, SE-701 82 Örebro, Sweden
| | - Karin Falk Brynhildsen
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, SE-701 82 Örebro, Sweden
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Do Triclosan Sutures Modify the Microbial Diversity of Surgical Site Infections? A Systematic Review and Meta-Analysis. Microorganisms 2022; 10:microorganisms10050927. [PMID: 35630370 PMCID: PMC9146332 DOI: 10.3390/microorganisms10050927] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 02/05/2023] Open
Abstract
Randomised controlled clinical trials (RCTs) report a lower incidence rate of surgical site infections (SSIs) with triclosan sutures (TSs) compared with non-triclosan sutures (NTSs). Do triclosan sutures modify the microbial diversity of culture-confirmed SSIs (ccSSIs)? If so, this would support the association between TS antimicrobial activity and the SSI incidence rate. This prospective systematic literature review (PROSPERO CRD42019125099) was conducted according to PRISMA. RCTs that compared the incidence of SSIs with TSs and NTSs and reported microbial counts from SSI cultures per suture group were eligible. The microbial species were grouped by genus, and the association between genera and sutures was tested. The pooled relative risk (RR) of ccSSIs was also calculated. Twelve RCTs were eligible. No publication bias was identified. The microorganism count was 180 in 124 SSIs with TSs versus 246 in 199 SSIs with NTSs. No significant difference in microbial diversity was found, but statistical power was low for test results to support or challenge the association between the antimicrobial activity of TSs and the reduced rate of SSIs. The RR of the ccSSIs was significant and consistent with comprehensive meta-analyses. The certainty of the pooled RR was moderate.
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7
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Sakurai H, Someya T, Yamamoto S, Kasahara I, Kuroki H, Shirai T. Short-Term Evaluation of a Novel No-Touch Technique for Harvesting Saphenous Veins With Long-Shafted Ultrasonic Scalpel. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:56-63. [PMID: 35225063 DOI: 10.1177/15569845221074463] [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: 11/16/2022]
Abstract
OBJECTIVE Saphenous vein grafts (SVGs) are widely used as bypass conduits in coronary artery bypass grafting. Compared with the conventional technique, the "no-touch" technique, wherein the saphenous veins are harvested with the surrounding tissue, may improve SVG patency; however, there are concerns regarding wound complications. To address this issue, we describe our novel no-touch technique with separate skin incisions using a long-shafted ultrasonic scalpel and report the clinical outcomes. METHODS We enrolled 66 male patients who underwent isolated coronary artery bypass grafting between April 2016 and April 2021. There were 30 and 36 patients treated using our no-touch technique and the conventional technique, respectively. The participants underwent coronary angiography before discharge and were followed clinically. SVG samples were taken for pathological examination. RESULTS SVGs harvested using our no-touch technique displayed preservation of the vessel wall structure and surrounding tissues. Our no-touch technique demonstrated no inferiority in patency compared with the conventional technique, and there was no SVG occlusion in the no-touch group. The frequency of leg wound complications was higher in the no-touch group than the conventional group, but no surgical site infections and severe complications occurred in the no-touch group. CONCLUSIONS SVGs harvested using our novel no-touch technique had similar pathological characteristics to those harvested using the original no-touch technique reported previously. Our no-touch technique maintained SVG patency and caused no severe wound complications. However, a large-scale, longitudinal study is required to accurately assess the clinical outcomes of our no-touch technique.
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Affiliation(s)
- Hironobu Sakurai
- Department of Cardiothoracic Surgery, 26842Ome Municipal General Hospital, Tokyo, Japan
| | - Takeshi Someya
- Department of Cardiothoracic Surgery, 26842Ome Municipal General Hospital, Tokyo, Japan
| | - Satoshi Yamamoto
- Department of Cardiothoracic Surgery, 26842Ome Municipal General Hospital, Tokyo, Japan
| | - Ichiro Kasahara
- Department of Diagnostic Pathology, 26842Ome Municipal General Hospital, Tokyo, Japan
| | - Hidehito Kuroki
- Department of Cardiothoracic Surgery, 26842Ome Municipal General Hospital, Tokyo, Japan
| | - Toshizumi Shirai
- Department of Cardiothoracic Surgery, 26842Ome Municipal General Hospital, Tokyo, Japan
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8
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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]
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Abstract
Surgical site infection (SSI) can be a significant complication of cardiac surgery, delaying recovery and acting as a barrier to enhanced recovery after cardiac surgery. Several risk factors predisposing patients to SSI including smoking, excessive alcohol intake, hyperglycemia, hypoalbuminemia, hypo- or hyperthermia, and Staphylococcus aureus colonization are discussed. Various measures can be taken to abolish these factors and minimize the risk of SSI. Glycemic control should be optimized preoperatively, and hyperglycemia should be avoided perioperatively with the use of intravenous insulin infusions. All patients should receive topical intranasal Staphylococcus aureus decolonization and intravenous cephalosporin if not penicillin allergic.
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Affiliation(s)
- Shruti Jayakumar
- Department of Cardiothoracic Surgery, St. George's Hospital, Blackshaw Road, London SW17 0QT, UK
| | - Ali Khoynezhad
- MemorialCare Heart and Vascular Institute, MemorialCare Long Beach Medical Center, 2801 Atlantic Avenue, Long Beach, CA 90806, USA
| | - Marjan Jahangiri
- Department of Cardiothoracic Surgery, St. George's Hospital, Blackshaw Road, London SW17 0QT, UK.
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Ruiz-Tovar J, Llavero C, Jimenez-Fuertes M, Duran M, Perez-Lopez M, Garcia-Marin A. Incisional Surgical Site Infection after Abdominal Fascial Closure with Triclosan-Coated Barbed Suture vs Triclosan-Coated Polydioxanone Loop Suture vs Polydioxanone Loop Suture in Emergent Abdominal Surgery: A Randomized Clinical Trial. J Am Coll Surg 2020; 230:766-774. [PMID: 32113031 DOI: 10.1016/j.jamcollsurg.2020.02.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/25/2019] [Accepted: 02/04/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Triclosan-coated sutures have been shown to reduce surgical-site infection (SSI) in emergent operation for fecal peritonitis. Barbed sutures provoke a homogeneous distribution of tension throughout the suture, implying better blood supply to the wound edges and healing. The aim of this study was to evaluate the effect, on SSI and evisceration, of using triclosan-coated and barbed sutures for fascial closure in patients undergoing emergent surgery. STUDY DESIGN A prospective, randomized clinical trial was performed. Patients were randomized into 3 groups: those undergoing aponeurotic closure with triclosan-coated barbed suture (Stratafix Symmetric [Johnson & Johnson]), patients undergoing closure with triclosan-coated polydioxanone loop suture (PDS plus [Johnson & Johnson]), and patients undergoing closure with polydioxanone loop suture (PDS [Johnson & Johnson]). Primary investigated outcomes were SSI and evisceration rates during a follow-up period of 30 days. The primary analysis plan was based on a per-protocol approach. RESULTS Incisional SSI was 6.4% (3 of 47) in the Stratafix Symmetric group, 8.9% (4 of 45) in the PDS plus group, and 23.4% (11 of 47) in PDS group (p = 0.03). The evisceration rate was 0% in Stratafix Symmetric, 8.9% (4 of 45) in PDS plus, and 12.8% (6 of 47) in PDS (p = 0.05). Median hospital stay was 4 days (range 2 to 14 days) in Stratafix Symmetric, 5 days (range 2 to 21 days) in PDS plus, and 8 days (range 2 to 60 days) in PDS (p = 0.012). The use of triclosan-coated sutures (Stratafix Symmetric and PDS plus) was associated with a lower risk of incisional SSI (p = 0.009), and the use of barbed suture was associated with a lower risk of evisceration (p = 0.019). Comparing Stratafix Symmetric with PDS plus, there were no significant differences in SSIs, but the evisceration rate was significantly higher in the PDS plus group (p = 0.036). CONCLUSIONS The use of triclosan-coated sutures (Stratafix Symmetric and PDS plus) in emergent surgery reduces the incidence of incisional SSIs. The use of barbed sutures reduces the incidence of evisceration.
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Affiliation(s)
- Jaime Ruiz-Tovar
- Department of Surgery, University Hospital Rey Juan Carlos, Madrid, Spain.
| | - Carolina Llavero
- Department of Surgical Nursery, University Hospital Sureste, Madrid, Spain
| | | | - Manuel Duran
- Department of Surgery, University Hospital Rey Juan Carlos, Madrid, Spain
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Stryja J, Sandy-Hodgetts K, Collier M, Moser C, Ousey K, Probst S, Wilson J, Xuereb D. PREVENTION AND MANAGEMENT ACROSS HEALTH-CARE SECTORS. J Wound Care 2020; 29:S1-S72. [DOI: 10.12968/jowc.2020.29.sup2b.s1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Jan Stryja
- Vascular Surgeon, Centre of vascular and miniinvasive surgery, Hospital Podlesi, Trinec, The Czech Republic. Salvatella Ltd., Centre of non-healing wounds treatment, Podiatric outpatients’ department, Trinec, The Czech Republic
| | - Kylie Sandy-Hodgetts
- Senior Research Fellow – Senior Lecturer, Faculty of Medicine, School of Biomedical Sciences, University of Western Australia, Director, Skin Integrity Clinical Trials Unit, University of Western Australia
| | - Mark Collier
- Nurse Consultant and Associate Lecturer – Tissue Viability, Independent – formerly at the United Lincolnshire Hospitals NHS Trust, c/o Pilgrim Hospital, Sibsey Road, Boston, Lincolnshire, PE21 9Q
| | - Claus Moser
- Clinical microbiologist, Rigshospitalet, Department of Clinical Microbiology, Copenhagen, Denmark
| | - Karen Ousey
- Professor of Skin Integrity, University of Huddersfield. Institute of Skin Integrity and Infection Prevention, Huddersfield, UK
| | - Sebastian Probst
- Professor of wound care, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Jennie Wilson
- Professor of Healthcare Epidemiology, University of West London, College of Nursing, Midwifery and Healthcare, London, UK
| | - Deborah Xuereb
- Senior Infection Prevention & infection Control Nurse, Mater Dei Hospital, Msida, Malta
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Larsson H, Hälleberg-Nyman M, Friberg Ö, Falk-Brynhildsen K. Perioperative routines and surgical techniques for saphenous vein harvesting in CABG surgery: a national cross-sectional study in Sweden. J Cardiothorac Surg 2020; 15:5. [PMID: 31915020 PMCID: PMC6950860 DOI: 10.1186/s13019-020-1056-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/03/2020] [Indexed: 11/17/2022] Open
Abstract
Background The saphenous vein is the most commonly used conduit for coronary artery bypass grafting (CABG). Wound healing complications related to saphenous vein harvesting are common, with reported surgical site infection rates ranging from 2 to 20%. Patients’ risk factors, perioperative hygiene routines, and surgical technique play important roles in wound complications. Here we describe the perioperative routines and surgical methods of Swedish operating theatre (OT) nurses and cardiac surgeons. Methods A national cross-sectional survey with descriptive design was conducted to evaluate perioperative hygiene routines and surgical methods associated with saphenous vein harvesting in CABG. A web-based questionnaire was sent to OT nurses and cardiac surgeons at all eight hospitals performing CABG surgery in Sweden. Results Responses were received from all hospitals. The total response rate was 62/119 (52%) among OT nurses and 56/111 (50%) among surgeons. Chlorhexidine 5 mg/mL in 70% ethanol was used at all eight hospitals. The OT nurses almost always (96.8%) performed the preoperative skin disinfection, usually for three to 5 minutes. Chlorhexidine was also commonly used before dressing the wound. Conventional technique was used by 78.6% of the surgeons, “no-touch” by 30.4%, and both techniques by 9%. None of the surgeons used endoscopic vein harvesting. Type of suture and technique used for closing the wound differed markedly between the centres. Conclusions In this article we present insights into the hygiene routines and surgical methods currently used by OT nurses and cardiac surgeons in Sweden. The results indicate both similarities and differences between the centres. Local traditions might be the most important factors in determining which procedures are employed in the OT. There is a lack of evidence-based hygiene routines and surgical methods.
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Santos PS, Santos M, Colafranceschi AS, Pragana ANDS, Correia MG, Simões HH, Rocha FA, Soggia MEDV, Santos APMS, Coutinho ADA, Figueira MS, Tura BR. Effect of Using Triclosan-Impregnated Polyglactin Suture to Prevent Infection of Saphenectomy Wounds in CABG: A Prospective, Double-Blind, Randomized Clinical Trial. Braz J Cardiovasc Surg 2019; 34:588-595. [PMID: 31719010 PMCID: PMC6852449 DOI: 10.21470/1678-9741-2019-0048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective To evaluate the efficacy of triclosan-coated suture for the reduction of
infection in saphenectomy wounds of patients undergoing coronary artery
bypass graft (CABG) surgery. Methods A total of 508 patients who underwent saphenectomy in CABG surgery were
included in a prospective, randomized, double-blind trial from February/2011
to June/2014. Patients were randomized into the triclosan-coated suture
group (n= 251) and the conventional non-antibiotic suture group (n=257).
Demographic (gender and age), clinical (body mass index, diabetes, and use
of analgesics), and intraoperative (cardiopulmonary bypass and cross-clamp
times) variables and those related to the saphenectomy wound (pain,
dehiscence, erythema, infection, necrosis, and hyperthermia) were measured
and analyzed. Results Of the 508 patients who underwent saphenectomy, 69.9% were males and 40.2%
were diabetic. Thirty-three (6.5%) patients presented infection: 13 (5.3%)
with triclosan and 20 (7.9%) with conventional suture
(P=0.281). Among diabetic patients (n=204), triclosan
suture was used in 45.1% with four cases of infection; conventional suture
was used in 54.9% of them, with 11 cases of infection. Most patients (94.3%)
underwent on-pump CABG. Wound pain was observed in 9.9% of patients with
triclosan-coated suture and in 17.9% with conventional suture
(P=0.011). Wound hyperthermia was found in 1.6% of
patients with triclosan-coated suture and in 5.4% of those with conventional
suture (P=0.028). Conclusion Triclosan-coated suture shows lower infection rate in saphenectomy of
patients undergoing CABG, although the differences were not statistically
significant. Pain and wound hyperthermia were less frequent in patients with
triclosan-coated sutures compared with conventional sutures.
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Affiliation(s)
- Paulo Samuel Santos
- Instituto Nacional de Cardiologia Department of Cardiovascular Surgery Rio de Janeiro RJ Brazil Department of Cardiovascular Surgery, Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ, Brazil
| | - Marisa Santos
- Instituto Nacional de Cardiologia Núcleo de Avaliação de Tecnologia em Saúde Rio de Janeiro RJ Brazil Núcleo de Avaliação de Tecnologia em Saúde (NATS), Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ, Brazil
| | - Alexandre Siciliano Colafranceschi
- Instituto Nacional de Cardiologia Department of Cardiovascular Surgery Rio de Janeiro RJ Brazil Department of Cardiovascular Surgery, Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ, Brazil
| | - Andrea Nunes de Souza Pragana
- Instituto Nacional de Cardiologia Department of Cardiovascular Surgery Rio de Janeiro RJ Brazil Department of Cardiovascular Surgery, Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ, Brazil
| | - Marcelo Goulart Correia
- Instituto Nacional de Cardiologia Department of Biostatistics and Bioinformatics Rio de Janeiro RJ Brazil Department of Biostatistics and Bioinformatics, Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ, Brazil
| | - Heloisa Helena Simões
- Instituto Nacional de Cardiologia Department of Cardiovascular Surgery Rio de Janeiro RJ Brazil Department of Cardiovascular Surgery, Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ, Brazil
| | - Fernando Alves Rocha
- Instituto Nacional de Cardiologia Department of Cardiovascular Surgery Rio de Janeiro RJ Brazil Department of Cardiovascular Surgery, Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ, Brazil
| | - Maria Eduarda de Vasconcelos Soggia
- Instituto Nacional de Cardiologia Department of Cardiovascular Surgery Rio de Janeiro RJ Brazil Department of Cardiovascular Surgery, Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ, Brazil
| | - Ana Paula Malta Samuel Santos
- Instituto Nacional de Cardiologia Department of Cardiovascular Surgery Rio de Janeiro RJ Brazil Department of Cardiovascular Surgery, Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ, Brazil
| | - Annie de Azeredo Coutinho
- Instituto Nacional de Cardiologia Núcleo de Avaliação de Tecnologia em Saúde Rio de Janeiro RJ Brazil Núcleo de Avaliação de Tecnologia em Saúde (NATS), Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ, Brazil
| | - Matheus Swarovsky Figueira
- Instituto Nacional de Cardiologia Department of Cardiovascular Surgery Rio de Janeiro RJ Brazil Department of Cardiovascular Surgery, Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ, Brazil
| | - Bernardo Rangel Tura
- Instituto Nacional de Cardiologia Department of Biostatistics and Bioinformatics Rio de Janeiro RJ Brazil Department of Biostatistics and Bioinformatics, Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ, Brazil
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Zucco R, Lavano F, Nobile CGA, Papadopoli R, Bianco A. Adherence to evidence-based recommendations for surgical site infection prevention: Results among Italian surgical ward nurses. PLoS One 2019; 14:e0222825. [PMID: 31557219 PMCID: PMC6762080 DOI: 10.1371/journal.pone.0222825] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/09/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The aims of the study were to assess the level of knowledge, the attitudes and the adherence to evidence-based recommendations for surgical site infection (SSI) prevention and to describe any influences that may motivate nurses to adopt evidence-based practices for SSI prevention. METHODS The present study was a national cross-sectional survey conducted from June to November 2017. For each hospital that agreed to participate, 30 nurses were randomly selected. The questionnaire was aimed at exploring socio-demographic and practice characteristics, knowledge of, attitudes toward, and reported practices regarding evidence-based procedures for SSI prevention. RESULTS Out of 55 hospitals that were contacted, 36 agreed to participate (a response rate of 65%). Of the original sample of 1313 nurses, a total of 1305 returned the questionnaire, a response rate of 99.4%. Regarding knowledge, only 53.8% knew that preoperative hair removal, if necessary, should take place shortly before surgery, and 28.9% of the sample did not know the right definition of "bundle". Over three quarters of participants stated that they always perform hand antisepsis before and after biological sample collection while 9.7% considered that wearing gloves during this practice is sufficient to prevent SSI. Furthermore, 91% of nurses reported that they always performed hand antisepsis before and after invasive procedures. CONCLUSION The study findings highlight the areas that were most lacking in nurses' training and for which targeted activities are needed. These data could support healthcare managers to implement interventions focused at enabling adherence to effective prevention practices to reduce risk to all patients.
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Affiliation(s)
- Rossella Zucco
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Francesco Lavano
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Carmelo G. A. Nobile
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Cosenza, Italy
| | - Rosa Papadopoli
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Aida Bianco
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
- * E-mail:
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Ahmed I, Boulton AJ, Rizvi S, Carlos W, Dickenson E, Smith NA, Reed M. The use of triclosan-coated sutures to prevent surgical site infections: a systematic review and meta-analysis of the literature. BMJ Open 2019; 9:e029727. [PMID: 31481559 PMCID: PMC6731927 DOI: 10.1136/bmjopen-2019-029727] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Surgical site infections (SSIs) represent a common and serious complication of all surgical interventions. Microorganisms are able to colonise sutures that are implanted in the skin, which is a causative factor of SSIs. Triclosan-coated sutures are antibacterial sutures aimed at reducing SSIs. Our objective is to update the existing literature by systematically reviewing available evidence to assess the effectiveness of triclosan-coated sutures in the prevention of SSIs. METHODS A systematic review of EMBASE, MEDLINE, AMED (Allied and complementary medicine database) and CENTRAL was performed to identify full text randomised controlled trials (RCTs) on 31 May 2019. INTERVENTION Triclosan-coated sutures versus non-triclosan-coated sutures. PRIMARY OUTCOME Our primary outcome was the development of SSIs at 30 days postoperatively. A meta-analysis was performed using a fixed-effects model. RESULTS Twenty-five RCTs were included involving 11 957 participants. Triclosan-coated sutures were used in 6008 participants and non triclosan-coated sutures were used in 5949. Triclosan-coated sutures significantly reduced the risk of SSIs at 30 days (relative risk 0.73, 95% CI 0.65 to 0.82). Further sensitivity analysis demonstrated that triclosan-coated sutures significantly reduced the risk of SSIs in both clean and contaminated surgery. CONCLUSION Triclosan-coated sutures have been shown to significantly reduced the risk of SSIs when compared with standard sutures. This is in agreement with previous work in this area. This study represented the largest review to date in this area. This moderate quality evidence recommends the use of triclosan-coated sutures in order to reduce the risk of SSIs particularly in clean and contaminated surgical procedures. PROSPERO REGISTRATION NUMBER CRD42014014856.
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Affiliation(s)
- Imran Ahmed
- Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | - Sana Rizvi
- Trauma and Orthopaedics, University Hospital Coventry, Coventry, UK
| | - William Carlos
- Trauma and Orthopaedics, University Hospital Coventry, Coventry, UK
| | | | - N A Smith
- Clinical Sciences Research Laboratories, University of Warwick, Coventry, UK
| | - Mike Reed
- Trauma and Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Northumberland, UK
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Sukeik M, George D, Gabr A, Kallala R, Wilson P, Haddad FS. Randomised controlled trial of triclosan coated vs uncoated sutures in primary hip and knee arthroplasty. World J Orthop 2019; 10:268-277. [PMID: 31363457 PMCID: PMC6650636 DOI: 10.5312/wjo.v10.i7.268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/29/2019] [Accepted: 07/08/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Triclosan-coated vicryl plus suture (Ethicon, Inc.) was developed to reduce microbial colonisation during surgical procedures. However, its effect on wound healing and surgical site infections remain unclear after hip and knee arthro-plasty surgery.
AIM To determine the effect of triclosan-coated sutures (TCS) vs non-coated sutures on wound healing, following primary hip and knee arthroplasties.
METHODS A single-centred, double-blind randomised controlled trial (RCT) was undertaken. We randomly allocated patients to receive either the triclosan-coated sutures (TCS vicryl plus) or non-coated sutures (NCS vicryl) during the closure of unilateral primary hip and knee arthroplasties. We utilised the ASEPSIS wound scoring system to evaluate wound healing for the first 6 weeks post-operatively.
RESULTS One hundred and fifty patients undergoing primary total hip or knee arthroplasty over a one-year period were included. Eighty-one were randomised to the TCS group and 69 to the NCS group. Despite no statistically significant difference in the ASEPSIS scores among the study groups (P = 0.75), sensitivity analysis using the Mann Whitney test (P = 0.036) as well as assessment of the wound complications at 6 weeks follow up, demonstrated significantly higher wound complication rates in the TCS group (8 vs 1, P = 0.03).
CONCLUSION No clear advantage was demonstrated for using the TCS. However, larger multi-centred RCTs are required to validate their use in hip and knee arthroplasty surgery.
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Affiliation(s)
- Mohamed Sukeik
- Department of Trauma and Orthopaedics, University College London Hospital, London NW1 2BU, United Kingdom
- Department of Trauma and Orthopaedics, Dr. Sulaiman Al-Habib Hospital – Al Khobar, King Salman Bin Abdulaziz Rd, Al Bandariyah, Al Khobar 34423, Saudi Arabia
| | - David George
- Department of Trauma and Orthopaedics, University College London Hospital, London NW1 2BU, United Kingdom
| | - Ayman Gabr
- Department of Trauma and Orthopaedics, University College London Hospital, London NW1 2BU, United Kingdom
| | - Rami Kallala
- Department of Trauma and Orthopaedics, University College London Hospital, London NW1 2BU, United Kingdom
| | - Peter Wilson
- Department of Clinical Microbiology, UCLH, London NW1 2PG, United Kingdom
| | - Fares Sami Haddad
- Department of Trauma and Orthopaedics, University College London Hospital, London NW1 2BU, United Kingdom
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Hassoun-Kheir N, Hasid I, Bozhko M, Shaban Z, Glam R, Hussein K, Paul M. Risk factors for limb surgical site infection following coronary artery bypass graft using open great saphenous vein harvesting: a retrospective cohort study. Interact Cardiovasc Thorac Surg 2019; 27:530-535. [PMID: 29688524 DOI: 10.1093/icvts/ivy137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 03/19/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Our goal was to define risk factors for limb (leg) surgical site infections (SSIs) following coronary artery bypass grafting (CABG) with open saphenous vein grafting and to estimate their consequences for patients. METHODS We performed a retrospective cohort study in a primary and tertiary hospital in Israel that included all adult patients undergoing CABG with open saphenous vein harvesting (November 2014-August 2016). Patients were followed perioperatively from admission until 90 days postoperatively, including post-discharge follow-up. Operative data were collected prospectively. We analysed risk factors for leg SSIs using univariate and multivariate methods. RESULTS Thirty-six of 351 (10.3%) patients developed leg SSI. Median time to detection was 14 days (interquartile range 11-24) and 25/36 (69.4%) patients were diagnosed after discharge. Independent risk factors for SSI included female sex [odds ratio (OR) 4.08, 95% confidence interval (CI) 1.79-9.28], body mass index >30 (OR 2.12, 95% CI 1.01-4.48), peripheral vascular disease (OR 3.33, 95% CI 1.48-7.49) and use of more than 1 saphenous vein graft (OR 2.08, 95% CI 0.88-4.96). Infected patients had longer hospitalizations after surgery [7 days (5-12) vs 6 days (5-7), P = 0.002], higher antibiotic consumption (P = 0.002) and higher readmission rates of 24/36 (66.7%) vs 59/262 (22.5%) (P < 0.001) than non-infected controls. CONCLUSIONS Leg SSIs following coronary artery bypass surgery are common and associated with morbidity. We suggest reconsidering open saphenous vein harvesting in obese female patients with peripheral vascular disease.
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Affiliation(s)
- Nasreen Hassoun-Kheir
- Infectious Diseases Institute, Rambam Heath Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Inon Hasid
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Masha Bozhko
- Department of Cardiovascular Surgery, Rambam Heath Care Campus, Haifa, Israel
| | - Ziyad Shaban
- Department of Cardiovascular Surgery, Rambam Heath Care Campus, Haifa, Israel
| | - Roi Glam
- Department of Cardiovascular Surgery, Rambam Heath Care Campus, Haifa, Israel
| | - Khetam Hussein
- Infectious Diseases Institute, Rambam Heath Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Mical Paul
- Infectious Diseases Institute, Rambam Heath Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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Rezk F, Åstrand H, Acosta S. Antibiotic Prophylaxis With Trimethoprim/Sulfamethoxazole Instead of Cloxacillin/Cefotaxime Increases Inguinal Surgical Site Infection Rate After Lower Extremity Revascularization. INT J LOW EXTR WOUND 2019; 18:135-142. [PMID: 31012368 DOI: 10.1177/1534734619838749] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Due to the consistently high proportion of surgical site infections (SSI) after vascular surgery, a change of prophylactic antibiotic therapy from cloxacillin/cefotaxime to trimethoprim/sulfamethoxazole (TMP-SMX) was conducted in 2016. The study included consecutive patients undergoing lower extremity revascularization due to acute or chronic lower extremity arterial disease. The antibiotic regime was changed in between the two sampling periods (2014 -2016 versus 2016 -2017). The diagnosis of SSI was based on clinical examination and microbiological results, and severity was classified according to the Szilagyi classification. One hundred and twenty-two patients in the cloxacillin/cefotaxime and 67 patients in the TMP-SMX group were included. The SSI rates were 32.0% and 40.3%, respectively (p=0.25). The proportion of women were higher in the TMP-SMX group (32.8% versus 47.8%, respectively, p=0.043). No other differences between the two groups were found regarding patient, vascular surgery procedure characteristics or severity of SSI. Groin infection rate was higher in the TMP-SMX group (15.4% versus 30.5%, respectively, p=0.022). When adjusting for gender, groin infection was more common in the TMP-SMX group (Odds Ratio 2.5, 95% CI 1.1 -5.4). The groin SSI rate was higher after elective surgery in the TMP-SMX group (13.0% versus 27.8%, respectively, p=0.027), and also after adjusting for gender (Odds Ratio 2.6, 95% CI 1.1 -6.2). The change in antibiotic prophylaxis from Cloxacillin/Cefotaxime to TMP-SMX was associated with an increased rate of inguinal SSI in patients undergoing lower extremity revascularization, despite a possible Hawthorne effect.
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Affiliation(s)
- Francis Rezk
- 1 Lund University, Lund, Sweden.,2 Jönköping Hospital, Jönköping, Sweden
| | | | - Stefan Acosta
- 1 Lund University, Lund, Sweden.,3 Skåne University Hospital, Malmö, Sweden
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19
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Nicolini F. Editorial on the article entitled "Secondary surgical-site infection after coronary artery bypass grafting: A multi-institutional prospective cohort study". J Thorac Dis 2019; 10:S3938-S3941. [PMID: 30631521 DOI: 10.21037/jtd.2018.09.70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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20
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Prävention postoperativer Wundinfektionen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:448-473. [PMID: 29589090 DOI: 10.1007/s00103-018-2706-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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21
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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).
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22
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Ruiz-Tovar J, Alonso N, Ochagavía A, Arroyo A, Llavero C. Effect of the Abdominal Fascial Closure with Triclosan-Coated Sutures in Fecal Peritonitis, on Surgical Site Infection, and Evisceration: A Retrospective Multi-Center Study. Surg Infect (Larchmt) 2018; 19:61-64. [PMID: 29303687 DOI: 10.1089/sur.2017.171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Surgical site infection (SSI) is a frequent complication in dirty surgery, reaching rates of up to 40%. The incidence of SSI might be influenced by the suture used for closure of the abdominal fascia. Sutures coated with antibacterial substances may reduce the bacterial load in the incision. PATIENTS AND METHODS A retrospective study of patients with intra-operative diagnosis of fecal peritonitis undergoing a laparotomy in three Spanish hospitals was performed. Fascial closure consisted in running loop suture of Polyglactin (Vicryl loop®, Johnson & Johnson, New Brunswick, NY; group 1), running loop suture of triclosan-coated polyglactin (Vicryl plus loop®; group 2), running loop suture of polydioxanone (PDS loop® Johnson & Johnson; group 3), and running loop suture of triclosan-coated polydioxanone (PDS plus loop®; group 4). Incisional SSI and evisceration rates were assessed. RESULTS One hundred four patients were included. There were no differences in age, gender, comorbidities, etiology of peritonitis, and mortality among groups. Surgical site infection rate was 34.6% in group 1; 8% in group 2; 33% in group 3; and 10% in group 4 (p = 0.029). The use of triclosan-coated sutures is associated with lower risk of SSI (risk ratio [RR]: 9; p = 0.003). Evisceration rate was 0% in groups 1 and 2; 15.2% in group 3; and 10% in group 4 (p = 0.05). All patients suffering from evisceration presented previous SSI. The use of monofilament sutures is associated with higher risk of evisceration (RR: 6.35; p = 0.033). CONCLUSION Triclosan-coated sutures reduce SSI rate in fecal peritonitis, without differences between braided and monofilament type. The use of monofilament sutures is related to higher risk of evisceration, independent of a triclosan coating.
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Affiliation(s)
- Jaime Ruiz-Tovar
- 1 Department of Surgery, University Hospital Rey Juan Carlos , Madrid, Spain
| | - Natalia Alonso
- 2 Department of Surgery, University Hospital Son Espases , Mallorca, Spain
| | - Aina Ochagavía
- 2 Department of Surgery, University Hospital Son Espases , Mallorca, Spain
| | - Antonio Arroyo
- 3 Department of Surgery, General University Hospital Elche , Alicante, Spain
| | - Carolina Llavero
- 4 Department of Surgical Nursery, Garcilaso Clinic , Madrid, Spain
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Aicher B, Curry P, Croal-Abrahams L, Hao S, Kalsi R, Menon N, Drucker C, Harris D, Toursavadkohi S, Crawford R, Rosenberger S. Infrainguinal wound infections in vascular surgery: An antiquated challenge without a modern solution. JOURNAL OF VASCULAR NURSING 2017; 35:146-156. [DOI: 10.1016/j.jvn.2017.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 03/16/2017] [Accepted: 03/16/2017] [Indexed: 12/11/2022]
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Konstantelias AA, Andriakopoulou CSI, Mourgela S. Triclosan-coated sutures for the prevention of surgical-site infections: a meta-analysis. Acta Chir Belg 2017; 117:137-148. [PMID: 28399780 DOI: 10.1080/00015458.2017.1287396] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The scope of this article is to perform a meta-analysis of the studies that compare the use of triclosan-coated sutures (TCS) to uncoated sutures in prevention of surgical-site infections (SSIs). METHODS A systematic search of randomized and non-randomized studies was carried out on Pubmed and Scopus databases until July 2016. RESULTS The meta-analysis of 30 studies (19 randomized, 11 non-randomized; 15,385 procedures) gave evidence that TCS were associated with a lower risk of SSIs (risk ratio [RR] = 0.68; 95% confidence interval [CI] 0.57-0.81). Triclosan-coated sutures were associated with lower risk for SSIs in high-quality randomized studies (Jadad score 4 or 5). A lower risk for the development of SSIs based on wound classification was observed in clean, clean-contaminated, and contaminated but not for dirty procedures. No benefit was observed in specific types of surgery: colorectal, cardiac, lower limb vascular or breast surgery. Only a trend was found for lower risk for wound dehiscence, whereas no difference was observed for all-cause mortality. CONCLUSIONS Further randomized studies are needed to confirm the role of TCS in specific surgical procedures and whether or not they are related with lower risk for mortality.
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Affiliation(s)
| | | | - Sofia Mourgela
- Department of Neurosurgery, Agios Savvas Cancer Hospital, Athens, Greece
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25
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Champeau M, Thomassin JM, Tassaing T, Jérôme C. Current manufacturing processes of drug-eluting sutures. Expert Opin Drug Deliv 2017; 14:1293-1303. [DOI: 10.1080/17425247.2017.1289173] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Mathilde Champeau
- Department of Chemistry, Centre for Education and Research on Macromolecules (CERM), University of Liège, Liège, Belgium
- Department of Chemistry, Institut des Sciences Moléculaires, UMR 5255 CNRS, Université Bordeaux, Groupe Spectroscopie Moléculaire, Talence Cedex, France
| | - Jean-Michel Thomassin
- Department of Chemistry, Centre for Education and Research on Macromolecules (CERM), University of Liège, Liège, Belgium
| | - Thierry Tassaing
- Department of Chemistry, Institut des Sciences Moléculaires, UMR 5255 CNRS, Université Bordeaux, Groupe Spectroscopie Moléculaire, Talence Cedex, France
| | - Christine Jérôme
- Department of Chemistry, Centre for Education and Research on Macromolecules (CERM), University of Liège, Liège, Belgium
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de Jonge SW, Atema JJ, Solomkin JS, Boermeester MA. Meta-analysis and trial sequential analysis of triclosan-coated sutures for the prevention of surgical-site infection. Br J Surg 2017; 104:e118-e133. [PMID: 28093723 DOI: 10.1002/bjs.10445] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/26/2016] [Accepted: 11/03/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND Triclosan-coated sutures (TCS) were developed to reduce the risk of surgical-site infection (SSI). Level 1A evidence of effectiveness has been presented in various recent meta-analyses, yet well designed RCTs have not been able to reproduce these favourable results. The aim of this study was to evaluate all available evidence critically with comprehensive analysis to seek a more reliable answer regarding the effectiveness of TCS in the prevention of SSI. METHODS PubMed, MEDLINE, Embase and Cochrane Library databases were searched from 1990 to November 2015 for RCTs that compared TCS with sutures that were exactly the same, but uncoated, in the prevention of SSI. Pooled relative risks (RRs) with corresponding 95 per cent confidence intervals were estimated using a random-effects model. Metaregression was used to substantiate subgroup effects, trial sequential analysis was employed to assess the risk of random error, and quality of evidence was determined using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. RESULTS Twenty-one RCTs including 6462 patients were included. Risk of bias was serious. Pooled effects showed a RR of 0·72 (95 per cent c.i. 0·60 to 0·86; P < 0·001) for all publications. At a risk of 138 SSIs per 1000 procedures, the use of TCS reduced this by 39 (95 per cent c.i. 19, 55). Trial sequential analysis confirmed a RR reduction of 15 per cent for the use of TCS. CONCLUSION GRADE assessment shows moderate-quality evidence that TCS are effective in reducing SSI. Trial sequential analysis indicates that the effect was robust, and additional data are unlikely to alter the summary effect.
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Affiliation(s)
- S W de Jonge
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - J J Atema
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - J S Solomkin
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - M A Boermeester
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
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Triclosan-containing sutures versus ordinary sutures for reducing surgical site infections in children: a double-blind, randomised controlled trial. THE LANCET. INFECTIOUS DISEASES 2017; 17:50-57. [DOI: 10.1016/s1473-3099(16)30373-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/19/2016] [Accepted: 07/26/2016] [Indexed: 01/27/2023]
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Allegranzi B, Zayed B, Bischoff P, Kubilay NZ, de Jonge S, de Vries F, Gomes SM, Gans S, Wallert ED, Wu X, Abbas M, Boermeester MA, Dellinger EP, Egger M, Gastmeier P, Guirao X, Ren J, Pittet D, Solomkin JS. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. THE LANCET. INFECTIOUS DISEASES 2016; 16:e288-e303. [PMID: 27816414 DOI: 10.1016/s1473-3099(16)30402-9] [Citation(s) in RCA: 486] [Impact Index Per Article: 60.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/28/2016] [Accepted: 09/13/2016] [Indexed: 12/11/2022]
Abstract
Surgical site infections (SSIs) are the most common health-care-associated infections in developing countries, but they also represent a substantial epidemiological burden in high-income countries. The prevention of these infections is complex and requires the integration of a range of preventive measures before, during, and after surgery. No international guidelines are available and inconsistencies in the interpretation of evidence and recommendations in national guidelines have been identified. Considering the prevention of SSIs as a priority for patient safety, WHO has developed evidence-based and expert consensus-based recommendations on the basis of an extensive list of preventive measures. We present in this Review 16 recommendations specific to the intraoperative and postoperative periods. The WHO recommendations were developed with a global perspective and they take into account the balance between benefits and harms, the evidence quality level, cost and resource use implications, and patient values and preferences.
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Affiliation(s)
- Benedetta Allegranzi
- Infection Prevention and Control Global Unit, Service Delivery and Safety, WHO, Geneva, Switzerland.
| | - Bassim Zayed
- Infection Prevention and Control Global Unit, Service Delivery and Safety, WHO, Geneva, Switzerland
| | - Peter Bischoff
- Institute of Hygiene and Environmental Medicine, Charité-University Medicine, Berlin, Germany
| | - N Zeynep Kubilay
- Infection Prevention and Control Global Unit, Service Delivery and Safety, WHO, Geneva, Switzerland
| | - Stijn de Jonge
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | - Fleur de Vries
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | | | - Sarah Gans
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | - Elon D Wallert
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | - Xiuwen Wu
- Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Mohamed Abbas
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marja A Boermeester
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | | | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité-University Medicine, Berlin, Germany
| | | | - Jianan Ren
- Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Didier Pittet
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; WHO Collaborating Centre on Patient Safety (Infection Control and Improving Practices), University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Joseph S Solomkin
- OASIS Global, Cincinnati, OH, USA; University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Yamashita K, Takeno S, Hoshino S, Shiwaku H, Aisu N, Yoshida Y, Tanimura S, Yamashita Y. Triclosan sutures for surgical site infection in colorectal cancer. J Surg Res 2016; 206:16-21. [DOI: 10.1016/j.jss.2016.06.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/31/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
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Karip AB, Çelik K, Aydın T, Yazıcılar H, İşcan Y, Ağalar C, Memişoğlu K. Effect of Triclosan-Coated Suture and Antibiotic Prophylaxis on Infection and Recurrence after Karydakis Flap Repair for Pilonidal Disease: A Randomized Parallel-Arm Double-Blinded Clinical Trial. Surg Infect (Larchmt) 2016; 17:583-8. [DOI: 10.1089/sur.2015.207] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Aziz Bora Karip
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Kafkas Çelik
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Timuçin Aydın
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Hanife Yazıcılar
- Department of Microbiology and Clinical Microbiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Yalın İşcan
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Canan Ağalar
- Department of Infectious Diseases and Clinical Microbiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Kemal Memişoğlu
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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Antimicrobial-coated sutures to decrease surgical site infections: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis 2016; 36:19-32. [DOI: 10.1007/s10096-016-2765-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/22/2016] [Indexed: 01/27/2023]
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Gudbjartsson T, Jeppsson A, Sjögren J, Steingrimsson S, Geirsson A, Friberg O, Dunning J. Sternal wound infections following open heart surgery – a review. SCAND CARDIOVASC J 2016; 50:341-348. [DOI: 10.1080/14017431.2016.1180427] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Anders Jeppsson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Sjögren
- Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden
| | - Steinn Steingrimsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Arnar Geirsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Orjan Friberg
- Department of Cardiothoracic Surgery, Orebro University Hospital, Orebro, Sweden
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
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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%.
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Dennis C, Sethu S, Nayak S, Mohan L, Morsi YY, Manivasagam G. Suture materials - Current and emerging trends. J Biomed Mater Res A 2016; 104:1544-59. [DOI: 10.1002/jbm.a.35683] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/07/2016] [Accepted: 02/05/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Christopher Dennis
- Centre for Biomaterials Science and Technology, School of Mechanical and Building Sciences, VIT University; Vellore Tamil Nadu 632014 India
| | - Swaminathan Sethu
- GROW Research Laboratory, Narayana Nethralaya Foundation; Bangalore Karnataka 560099 India
| | - Sunita Nayak
- Centre for Biomaterials Science and Technology, School of Mechanical and Building Sciences, VIT University; Vellore Tamil Nadu 632014 India
- School of Bio Sciences and Technology, VIT University; Vellore Tamil Nadu 632014 India
| | - Loganathan Mohan
- Surface Engineering Division; CSIR - National Aerospace Laboratories; Bangalore Karnataka 560017 India
| | - Yosry Yos Morsi
- Biomechanical and Tissue Engineering Labs, Faculty of Science, Engineering and Technology, Swinburne University of Technology; Australia
| | - Geetha Manivasagam
- Centre for Biomaterials Science and Technology, School of Mechanical and Building Sciences, VIT University; Vellore Tamil Nadu 632014 India
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35
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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.
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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.
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36
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O'Neal PB, Itani KMF. Antimicrobial Formulation and Delivery in the Prevention of Surgical Site Infection. Surg Infect (Larchmt) 2016; 17:275-85. [PMID: 26910558 DOI: 10.1089/sur.2015.272] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND A number of adjunct antimicrobial measures have been studied in an attempt to reduce surgical site infection (SSI) rates. In addition to parenteral antibiotic prophylaxis, these measures include oral antibiotics in bowel preparation for colorectal surgery, antiseptic/antimicrobial irrigation, antimicrobial sutures, local antibiotics, skin incision antibacterial sealants, and antimicrobial dressings. It is the purpose of this review to study the evidence behind each of these measures and to evaluate relevant data for recommendations in each area. METHODS A systematic review of the literature through PubMed was performed. RESULTS Need for adequate dosing and re-dosing of intravenous peri-operative antibiotics, duration of antibiotic usage past wound closure, and the use of antibiotic bowel preparation in colorectal surgery are well defined in the published literature. However, data on local antimicrobial measures remain controversial. CONCLUSIONS Proper dosing and re-dosing of prophylactic intravenous antibiotics should become standard practice. Continuation of intravenous antibiotic prophylaxis beyond wound closure is unnecessary in clean cases and remains controversial in clean-contaminated and complex cases. Oral antibiotic bowel preparation is an important adjunct to intravenous antibiotic prophylaxis in colorectal surgery. The use of topical antimicrobial and antiseptic agents such as antibacterial irrigations, local antimicrobial application, antimicrobial-coated sutures, antibacterial wound sealants, and antimicrobial impregnated dressings in the prevention of SSI is questionable.
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Affiliation(s)
- Patrick B O'Neal
- 1 Veterans Administration Boston Health Care System , West Roxbury, Massachusetts.,2 Department of Surgery, Boston University , Boston, Massachusetts
| | - Kamal M F Itani
- 1 Veterans Administration Boston Health Care System , West Roxbury, Massachusetts.,2 Department of Surgery, Boston University , Boston, Massachusetts
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37
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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.
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38
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Daoud FC. Systematic literature review update of the PROUD trial: potential usefulness of a collaborative database. Surg Infect (Larchmt) 2015; 15:857-8. [PMID: 25317784 DOI: 10.1089/sur.2014.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Frederic C Daoud
- Unit of Biostatistics & Bioinformatics, Medextens , Paris, France
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39
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Triclosan-coated sutures and sternal wound infections: a prospective randomized clinical trial. Eur J Clin Microbiol Infect Dis 2015; 34:2331-8. [DOI: 10.1007/s10096-015-2485-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 08/30/2015] [Indexed: 10/23/2022]
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Hasselmann J, Kühme T, Acosta S. Antibiotic Prophylaxis With Trimethoprim/Sulfamethoxazole Instead of Cloxacillin Fails to Improve Inguinal Surgical Site Infection Rate After Vascular Surgery. Vasc Endovascular Surg 2015; 49:129-34. [DOI: 10.1177/1538574415600531] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Surgical site infections (SSIs) and their prevention continue to be a major point of focus in all surgical specialties today. Antibiotic prophylaxis is one of the mainstays in their prevention. Due to the consistently high proportion of infections caused by intestinal flora from the start of our wound surveillance registry in 2005, we conducted a change in prophylactic antibiotic therapy from cloxacillin in 2012 to trimethoprim/sulfamethoxazole (TMP-SMX) in 2013. Methods: The study included all patients undergoing vascular surgery with groin incisions between March 1 and June 30 in 2012 and 2013, respectively, whereby the antibiotic regime was changed in between the 2 sampling periods. The diagnosis of SSI was based on clinical examination and microbiological results. Results: Two hundred nineteen patients with inguinal incisions were included in the analysis: 105 in the cloxacillin group of which 19% had SSI and 114 in the TMP-SMX group with an SSI rate of 18% ( P = .77), without differences between the 2 groups regarding age, gender, proportion of emergency surgery, type of surgery, or frequency of concomitant foot ulcers. The high proportion of infections caused by intestinal flora between time periods was unchanged (67% vs 81%, P = .34). Conclusion: There was no difference between the 2 groups, suggesting that the choice of antibiotic prophylaxis had a limited role in preventing SSI at our center. Despite this, the lower cost and ease of the administration of TMP-SMX can be seen as convincing advantages.
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Affiliation(s)
- Julien Hasselmann
- Department of Clinical Sciences, Lund University/Vascular Center, Malmö-Lund, Skåne University Hospital, Malmö, Sweden
| | - Tobias Kühme
- Department of Clinical Sciences, Lund University/Vascular Center, Malmö-Lund, Skåne University Hospital, Malmö, Sweden
| | - Stefan Acosta
- Department of Clinical Sciences, Lund University/Vascular Center, Malmö-Lund, Skåne University Hospital, Malmö, Sweden
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41
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Turtiainen J, Hakala T. Comments on the Article: "Meta-Analysis of Prevention of Surgical Site Infections after Incision Closure with Triclosan-Coated Sutures: Robustness to New Evidence". Surg Infect (Larchmt) 2015; 16:645-6. [PMID: 26114623 DOI: 10.1089/sur.2014.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Johanna Turtiainen
- Department of Surgery, North Karelia Central Hospital , Joensuu, Finland
| | - Tapio Hakala
- Department of Surgery, North Karelia Central Hospital , Joensuu, Finland
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Hernandez KA, Hooper RC, Boyko T, Golas AR, van Harten M, Wu D, Weinstein A, Chu C, Spector JA. Reduction of suture associated inflammation after 28 days using novel biocompatible pseudoprotein poly(ester amide) biomaterials. J Biomed Mater Res B Appl Biomater 2014; 103:457-63. [DOI: 10.1002/jbm.b.33211] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 03/31/2014] [Accepted: 05/17/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Karina A. Hernandez
- Division of Plastic and Reconstructive Surgery; Weill Cornell Medical College; New York
| | | | - Tatiana Boyko
- Division of Plastic and Reconstructive Surgery; Weill Cornell Medical College; New York
| | - Alyssa R. Golas
- Division of Plastic and Reconstructive Surgery; Weill Cornell Medical College; New York
| | - Michel van Harten
- Division of Plastic and Reconstructive Surgery; Weill Cornell Medical College; New York
| | - D.Q. Wu
- Department of Fiber Science and Apparel Design; and Biomedical Engineering Program; Cornell University; Ithaca New York
| | - Andrew Weinstein
- Division of Plastic and Reconstructive Surgery; Weill Cornell Medical College; New York
| | - C.C. Chu
- Department of Fiber Science and Apparel Design; and Biomedical Engineering Program; Cornell University; Ithaca New York
| | - Jason A. Spector
- Division of Plastic and Reconstructive Surgery; Weill Cornell Medical College; New York
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Daoud FC, Edmiston CE, Leaper D. Meta-analysis of prevention of surgical site infections following incision closure with triclosan-coated sutures: robustness to new evidence. Surg Infect (Larchmt) 2014; 15:165-81. [PMID: 24738988 DOI: 10.1089/sur.2013.177] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A systematic literature review (SLR) and meta-analysis of surgical site infections (SSIs) after surgical incision closure with triclosan-coated sutures (TS) compared with non-antibacterial coated sutures (NTS) published previously by the authors suggested that fewer SSIs occurred in the TS study arm. However, the results were vulnerable to the removal of one key randomized controlled trial (RCT) because of insufficient data. Furthermore, recently published RCTs highlighted the need for an update of the SLR to challenge the robustness of results. METHODS The protocol for the new SLR included more stringent tests of robustness than used initially and the meta-analysis was updated with the results of two new RCTs as well as the count of patients and SSIs by U.S. Centers for Disease Control and Prevention (CDC) incision class. RESULTS The updated SLR included 15 RCTs with 4,800 patients. No publication bias was suggested in the analysis. The predominant effect estimated a relative risk of 0.67 (95% CI: 0.54-0.84, p=0.00053) with an overall lower frequency of SSI in the TS arm than in the NTS arm. RESULTS were robust to sensitivity analysis. CONCLUSIONS The two additional peer-reviewed double-blind RCTs of this update confirmed the predominant effect found in the authors' previous meta-analysis and established the robustness of conclusions that were lacking previously. This SLR and meta-analysis showed that the use of triclosan antimicrobial sutures reduced the incidence of SSI after clean, clean-contaminated, and contaminated surgery. The two additional peer-reviewed double blind RCTs reinforced the evidence level of this SLR (CEBM level 1a).
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Affiliation(s)
- Frederic C Daoud
- 1 Unit of Biostatistics and Bioinformatics, Medextens , Paris, France
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Abstract
Surgical wound infection is one of the most common complications after peripheral vascular surgery. It increases the affected patient's risk for major amputation as well as mortality. Furthermore, surgical wound infection is an additional cost. Wound infections after vascular surgery are of multifactorial nature and generally result from the interplay of patient- and procedure-related factors. The use of systemic antibiotic prophylaxis may be the most important method in preventing surgical wound infections. In this review article, we report the current literature of surgical wound infections after peripheral vascular surgery.
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Affiliation(s)
- J Turtiainen
- Department of Surgery, North Karelia Central Hospital, Joensuu, Finland
| | - T Hakala
- Department of Surgery, North Karelia Central Hospital, Joensuu, Finland
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Kopjar T, Dashwood MR, Gasparovic H, Biocina B. No difference in 1-year wound morbidity following no-touch versus conventional vein harvesting for coronary artery bypass surgery: a new beginning. Eur J Cardiothorac Surg 2014; 46:1043-4. [PMID: 24711509 DOI: 10.1093/ejcts/ezu149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tomislav Kopjar
- Department of Cardiac Surgery, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Hrvoje Gasparovic
- Department of Cardiac Surgery, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Bojan Biocina
- Department of Cardiac Surgery, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
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Verma S, Lovren F, Pan Y, Yanagawa B, Deb S, Karkhanis R, Quan A, Teoh H, Feder-Elituv R, Moussa F, Souza DSR, Fremes SE. Pedicled no-touch saphenous vein graft harvest limits vascular smooth muscle cell activation: the PATENT saphenous vein graft study. Eur J Cardiothorac Surg 2013; 45:717-25. [PMID: 24327455 DOI: 10.1093/ejcts/ezt560] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Neointimal hyperplasia secondary to vascular smooth muscle cell (VSMC) activation limits the long-term patency of saphenous vein grafts (SVGs). We compared markers of vascular injury and VSMC activation in SVGs harvested using the pedicled 'no-touch' (NT) vs the conventional (CON) technique. METHODS Patients undergoing coronary artery bypass surgery were enrolled in the PATENT SVG trial (clinicaltrials.gov NCT01488084). Patients were randomly allocated to have SVGs harvested with the NT technique from one leg and the CON method from the other. SVG segments underwent morphometry, histological and electron microscopy assessments and transcript measurements of VSMC activation and differentiation markers. Leg wound functional recovery and harvest site complications were assessed using a quality-of-life questionnaire. RESULTS A total of 17 patients (65.3 ± 7.3 years) were enrolled. SVGs harvested using the NT vs CON technique exhibited preserved intimal, medial and adventitial architecture. CON harvest was associated with greater medial Kruppel-like factor 4 transcript levels (0.26 ± 0.05 vs 0.11 ± 0.02, P < 0.05). CON samples had significantly lower medial serum response factor (0.53 ± 0.11 vs 1.44 ± 0.50, P < 0.05) and myocardin (0.59 ± 0.08 vs 1.33 ± 0.33, P < 0.05) transcript levels. MicroRNA-145, an inhibitor of VSMC activation and differentiation, was higher in the NT vs CON samples (1.84 ± 1.03 vs 0.50 ± 0.19, P < 0.05). Leg assessment scores were worse in the NT legs at 3 months, but similar to CON scores at 12 months. CONCLUSIONS SVGs harvested using the 'NT' technique exhibit an early molecular and morphological pattern consistent with decreased VSMC activation compared with CON harvesting. Functional leg recovery was similar in both groups at 12 months. Larger studies are required to corroborate these findings.
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Affiliation(s)
- Subodh Verma
- Division of Cardiac Surgery, Keenan Research Centre in the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, ON, Canada
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Jeppsson A, Thimour-Bergström L, Friberg Ö, Gudbjartsson T. Reply to Turtiainen and Hakala. Eur J Cardiothorac Surg 2013; 45:957. [PMID: 23921160 DOI: 10.1093/ejcts/ezt404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Anders Jeppsson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Turtiainen J, Hakala T. Does the use of triclosan-coated sutures really reduce surgical site infection after open vein bypass grafting patients? Eur J Cardiothorac Surg 2013; 45:956. [PMID: 23921162 DOI: 10.1093/ejcts/ezt403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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