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Liang K, Liu Y, Jiang F. Analysis of therapeutic effect of silver-based dressings on chronic wound healing. Int Wound J 2024; 21:e70006. [PMID: 39087750 PMCID: PMC11292664 DOI: 10.1111/iwj.70006] [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: 03/28/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 08/02/2024] Open
Abstract
Chronic wounds are susceptible to bacterial infections and at high risk of developing antibiotic-resistant bacterial infections. Silver is an antimicrobial by targeting almost all types of bacteria in chronic wounds to reduce the bacterial load in the infected area and further facilitate the healing process. This study focused on exploring whether silver-based dressings were superior to non-silver dressings in the treatment of chronic wounds. PubMed, Web of Science and Embase were comprehensively searched from inception to March 2024 for randomized clinical trials and observational studies. The endpoints in terms of wound healing rate, complete healing time, reduction on wound surface area and wound infection rate were analysed using Review Manager 5.4 software. A total of 15 studies involving 5046 patients were eventually included. The results showed that compared with patients provided with non-silver dressings, patients provided with silver-based dressings had higher wound healing rate (OR: 1.43, 95% CI: 1.10-1.85, p = 0.008), shorter complete healing time (MD: -0.96, 95% CI: -1.08 ~ -0.85, p < 0.00001) and lower wound infection rate (OR: 0.56, 95% CI: 0.40-0.79, p = 0.001); no significant difference in the reduction on wound surface area (MD: 12.41, 95% CI: -19.59-44.40, p = 0.45) was found. These findings suggested that the silver-based dressings were able to enhance chronic wound healing rate, shorten the complete healing time and reduce wound infection rate, but had no significant improvement in the reduction on wound surface area. Large-scale and rigorous studies are required to confirm the beneficial effects of silver-based dressings on chronic wound healing.
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Affiliation(s)
- Kaitao Liang
- Trauma Orthopedics DepartmentThe Affiliated Panyu Central Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Yan Liu
- Intensive Care MedicineZhongshan Hospital of Traditional Chinese MedicineZhongshanChina
| | - Fengting Jiang
- Trauma Orthopedics DepartmentThe Affiliated Panyu Central Hospital of Guangzhou Medical UniversityGuangzhouChina
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Chen J, Zhao J, Wu H, Wang T, Gao C. Efficacy and safety of oral probiotic supplementation in mitigating postoperative surgical site infections in patients undergoing colorectal cancer surgery: A systematic review and meta-analysis. Int Wound J 2024; 21:e14603. [PMID: 38155392 PMCID: PMC10961893 DOI: 10.1111/iwj.14603] [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: 11/02/2023] [Revised: 12/09/2023] [Accepted: 12/10/2023] [Indexed: 12/30/2023] Open
Abstract
Surgical site infections (SSIs) pose significant risks to patients undergoing colorectal cancer (CRC) surgery. With increasing evidence on the benefits of oral probiotics in various clinical contexts, there is a need to assess their efficacy and safety in reducing SSIs following CRC surgery. A systematic review and meta-analysis were conducted in line with PRISMA guidelines using the PICO framework. On 19 September 2023, four major databases (PubMed, Embase, Web of Science and Cochrane Library) were searched without any temporal or language restrictions. Rigorous inclusion and exclusion criteria were employed. Data extraction was independently undertaken by two assessors, and any discrepancies were discussed. The Cochrane Collaboration's risk of bias instrument was utilized to assess study quality. The meta-analysis incorporated a fixed-effects model or random-effects model based on the I2 statistic to assess heterogeneity. The initial search yielded 1282 articles, of which 10 met the inclusion criteria and were analysed. Probiotic administration not only significantly reduced the incidence of SSIs but also curtailed the duration of hospital stays. Moreover, the subgroup analysis indicated that interventions employing multiple strains of probiotics were more effective in reducing postoperative infections than those utilizing a single strain. Probiotics effectively prevent postoperative infections and shorten hospital stays. Multi-strain probiotics outperform single strain in efficacy. Future studies should focus on their safety and optimal clinical use.
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Affiliation(s)
- Jiahong Chen
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, The First Dongguan Affiliated HospitalGuangdong Medical UniversityDongguanChina
- Department of Venereal Diseases and Integrated Chinese and Western Medicine and Bone ParalysisThe Third Hospital of Guangdong Medical University (Longjiang Hospital of Shunde District)FoshanChina
| | - Jie Zhao
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, The First Dongguan Affiliated HospitalGuangdong Medical UniversityDongguanChina
- Personnel SectionHuadu Clinical Medical College of Guangdong Medical University (Maternal and Child Health Hospital)GuangzhouChina
| | - Hongfu Wu
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, The First Dongguan Affiliated HospitalGuangdong Medical UniversityDongguanChina
| | - Tao Wang
- Department of Venereal Diseases and Integrated Chinese and Western Medicine and Bone ParalysisThe Third Hospital of Guangdong Medical University (Longjiang Hospital of Shunde District)FoshanChina
| | - Cifeng Gao
- Personnel SectionHuadu Clinical Medical College of Guangdong Medical University (Maternal and Child Health Hospital)GuangzhouChina
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Prabha Shankar A, Br KK, Shankar B, Babu RH, Dholariya R, Priya, Muralidhar S, Subramanya GM. Oncological Surgical Wound Care: A Comparison of Theruptor NXT Non-adherent Dressing and the Current Standard of Care. Cureus 2024; 16:e56593. [PMID: 38650774 PMCID: PMC11034897 DOI: 10.7759/cureus.56593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/25/2024] Open
Abstract
Background Oncological surgeries pose an elevated risk of surgical site infections (SSIs) due to their complexity and various associated treatments, impacting patient outcomes and healthcare costs. This has prompted a focus on advanced wound dressings that provide microbial protection, exudate absorption, and improved product performance, enhancing patient satisfaction. Our study aimed to compare the efficacy and safety of Theruptor NXT with the current standard of care (SOC) practice involving cotton/povidone/micropore dressings in the postoperative wound management of oncological surgeries. Methodology A total of 102 patients who underwent oncological surgeries in the Department of Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, India between May and September 2023 were randomized to Theruptor NXT and SOC dressing groups (51 patients each). The incidence of SSIs, wound pain score, cosmetic appearance of the wound, and adverse events were assessed in the two groups at various intervals, i.e., post-surgery day 2 ± 1, day of discharge, and post-surgery day 30 ± 7. Further, the subject satisfaction and product usage were evaluated on post-surgery day 2 ± 1. Results The baseline characteristics were found to be comparable in both groups, i.e., Theruptor NXT and SOC groups. Further, the SSI rates, scar outcomes, and physiological parameters were also similar between the Theruptor NXT and SOC groups, indicating a similar safety profile of both dressings (p > 0.05). However, the product usage assessment revealed statistically significant differences, favoring Theruptor NXT in terms of superior ease of application, stretchability, exudate management, breathability, and non-adherence properties (p < 0.05). Conclusions Our findings suggest that Theruptor NXT wound dressing is a promising, effective, and user-friendly alternative to SOC wound dressing in diverse clinical settings.
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Affiliation(s)
- Amritha Prabha Shankar
- Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - Kiran Kumar Br
- Radiation Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - Bharat Shankar
- Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - Ravoori H Babu
- Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - Rahul Dholariya
- Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - Priya
- Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - Shubhashree Muralidhar
- Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - Ganesh M Subramanya
- Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
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Kosugi C, Koda K, Shimizu H, Yamazaki M, Shuto K, Mori M, Usui A, Nojima H, Endo S, Yanagibashi H, Arimitsu H, Tochigi T, Sazuka T, Hirota M, Kuboki H. A Randomized Trial of Ionic Silver Dressing to Reduce Surgical Site Infection After Gastrointestinal Surgery. ANNALS OF SURGERY OPEN 2024; 5:e402. [PMID: 38883952 PMCID: PMC11175960 DOI: 10.1097/as9.0000000000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/19/2024] [Indexed: 06/18/2024] Open
Abstract
Objective To determine whether Aquacel Ag Hydrofiber dressings containing ionic silver are superior to film dressings for preventing superficial surgical site infections (SSI) in patients undergoing elective gastrointestinal surgery. Background Multiple clinical trials have assessed the effectiveness of silver-containing wound dressings; however, systematic reviews failed to find any advantages of these dressings and concluded that there was insufficient evidence to indicate that they prevented wound infections. This study aimed to evaluate the efficacy of Aquacel Ag Hydrofiber dressings for preventing superficial SSIs in patients undergoing gastrointestinal surgery. Methods Patients undergoing elective gastrointestinal surgery were randomly assigned to receive either Aquacel Ag Hydrofiber (study group) or film dressings (control group). The primary end point was superficial SSI within 30 days after surgery (UMIN Clinical Trials Registry ID: 000043081). Results A total of 865 patients (427 study group, 438 control group) were qualified for primary end-point analysis. The overall rate of superficial SSIs was significantly lower in the study group than in the control group (6.8% vs 11.4%, P = 0.019). There was no significant difference in superficial SSI rates between the groups in patients undergoing upper gastrointestinal surgery; however, the rate was significantly lower in the study group in patients undergoing lower gastrointestinal surgery (P = 0.042). Multivariate analysis identified Aquacel Ag Hydrofiber dressings as an independent factor for reducing superficial SSIs (odds ratio, 0.602; 95% confidence interval, 0.367-0.986; P = 0.044). Conclusions Aquacel Ag Hydrofiber dressings can reduce superficial SSIs compared to film dressings in patients undergoing elective gastrointestinal surgery, especially lower gastrointestinal surgery.
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Affiliation(s)
- Chihiro Kosugi
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Keiji Koda
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Hiroaki Shimizu
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Masato Yamazaki
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Kiyohiko Shuto
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Mikito Mori
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Akihiro Usui
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Hiroyuki Nojima
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Satoshi Endo
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Hiroo Yanagibashi
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Hidehito Arimitsu
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Toru Tochigi
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Tetsutaro Sazuka
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Mihono Hirota
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Hideyuki Kuboki
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
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Whitley A, Baláž P, Kavalírek J, Hanusová J, Gürlich R. Evaluating the impact of an anti-microbial silver-impregnated surgical dressing on wound infections and healing: A randomised clinical trial. Wound Repair Regen 2024; 32:67-73. [PMID: 38111101 DOI: 10.1111/wrr.13142] [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: 08/08/2023] [Revised: 10/09/2023] [Accepted: 11/19/2023] [Indexed: 12/20/2023]
Abstract
StopBac is an innovative silver-impregnated antimicrobial dressing specifically designed to reduce surgical site infections and enhance healing. The primary objective of this study was to compare infection healing rate at 30 days after surgery between primarily closed surgical wounds covered with StopBac and those covered with Cosmorpor, a standard surgical dressing. Between 1.3.2023 and 30.4.2023, we conducted a prospective screening of all patients undergoing surgical operations within a single surgical department. Patients were randomised into either the Cosmopor group or the StopBac group. Outcome measures were superficial and deep surgical site infections and healed wounds. Data concerning patient and surgical factors were prospectively collected and analysed. The analysis comprised 275 patients, divided into two groups: 140 patients in the StopBac group and 135 in the Cosmopor group. The StopBac dressing was associated with a reduced rate of infection, with an odds ratio of 0.288 (p < 0.001), and an increased likelihood of wound healing at 30 days after surgery. The odds ratio for healing at 30 days was 4.661 (p < 0.001). StopBac was associated with a lower incidence of surgical wound infections and a higher probability of healing at 30 days after surgery, when compared with standard dressing.
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Affiliation(s)
- Adam Whitley
- Department of Surgery, University Hospital Královské Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Peter Baláž
- Department of Surgery, University Hospital Královské Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Vascular Surgery, Cardiocenter, University Hospital Královské Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Kavalírek
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Jitka Hanusová
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Robert Gürlich
- Department of Surgery, University Hospital Královské Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
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Wang X, Fu L, Guo S, Fang X. A meta-analysis examined the effect of topical nursing application of antimicrobial as a prophylaxis for the stoppage of surgical wound infection in colorectal surgery. Int Wound J 2023. [PMID: 36727574 DOI: 10.1111/iwj.14064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 02/03/2023] Open
Abstract
To assess the impact of topical antimicrobial (TA) as a prophylaxis for the stoppage of surgical wound infection (SWI) in colorectal surgery (CS), we lead a meta-analysis. 9160 participants with CS were enrolled in the chosen studies; 4719 of them used TA, while 4441 served as controls. To assess the effectiveness of TA application in lowering SWIs following CS, odds ratios (OR) with 95% confidence intervals (CIs) were computed with a dichotomous technique with a fixed- or random-effect model. Significantly lower SWIs post CS for TA as whole (OR, 0.50; 95% CI, 0.38-0.64; P < .001), gentamicin collagen sponge and beads (OR, 0.52; 95% CI, 0.32-0.86; P = .01), triclosan impregnated fascial suture (OR, 0.57; 95% CI, 0.38-0.84; P = .005), antibiotic powder, ointment, lavage, or injection for the abdominal wound (OR, 0.35; 95% CI, 0.21-0.59; P < .001), and ionised silver dressing on the closed abdominal wound (OR, 0.45; 95% CI, 0.27-0.77; P = .003) compared to control. Significantly lower SWIs post CS for TA as a whole, gentamicin collagen sponge and beads, triclosan impregnated fascial sutures, antibiotic powder, ointment, lavage, or injection for the abdominal wound, and ionised silver dressing on the closed abdominal wound compared with control. The low sample size of 8 out of the 39 included studies in this meta-analysis calls for precaution when analysing the outcomes.
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Affiliation(s)
- Xue Wang
- School of Nursing, Jilin University, Jilin, P.R. China
| | - Liming Fu
- Department of Traditional Chinese Medicine, Bethune First Hospital of Jilin University, Changchun, P.R. China
| | - Shaoning Guo
- Department of Nursing, Bethune First Hospital Of Jilin University, Changchun, P.R. China
| | - Xuedong Fang
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Jilin, P.R. China
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Dressing to prevent surgical site infection in adult patients with cancer: a systematic review with meta-analysis. Support Care Cancer 2022; 31:11. [PMID: 36512091 DOI: 10.1007/s00520-022-07467-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To identify the most effective dressing for application to surgical wounds with primary closure to prevent surgical site infection (SSI) in adult patients with cancer undergoing elective surgeries. METHODS This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, with online searches conducted in the CINHAL, Cochrane Central, LILACS, PubMed, Scopus, Embase, Livivo, and Web of Science databases. An additional search was conducted in gray literature using Google Scholar. The risk of bias was assessed using RoB 2.0. The certainty of evidence was evaluated using the Grading of Recommendations Assessment and Development and Evaluation, and the results were synthesized in a descriptive manner and using meta-analysis. RESULTS Eleven randomized clinical trials were conducted to compare different types of dressing-silver dressing with absorbent dressing (n = 3), mupirocin dressing with paraffin/no dressing (n = 1), honey-based dressing with absorbent dressing (n = 1), vitamin E and silicone-containing dressing with absorbent dressing (n = 1), and negative pressure wound therapy with absorbent dressing (n = 4)-and compare the usage duration of absorbent dressing (n = 1). Nine trials presented a low risk of bias, and two were classified as having uncertain bias. Compared with absorbent dressing, silver dressing did not reduce the risk of developing any type of SSI in 894 clinical trial participants (risk relative RR: 0.72; 95% confidence interval [CI] [0.44, 1.17] p = 0.18). Compared with absorbent dressing, negative pressure wound therapy did not reduce the risk of developing any type of SSI in the 1041 participants of two clinical trials (RR 0.68; 95% CI [0.31, 1.26] p = 0.22). The certainty of evidence of the three meta-analyses was considered low or very low for the prevention of SSI. We believe that this low certainty of evidence can be improved by conducting new studies in the future. CONCLUSION There is no evidence regarding which dressing is the most effective in preventing SSI in adult patients with cancer.
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Goodman JR, Durazo-Arvizu R, Nashif S, McAlarnen LA, Wagner SA, Lal AK. Preventing caesarean section wound complications: use of a silver-impregnated antimicrobial occlusive dressing. J Wound Care 2022; 31:S5-S14. [PMID: 35797250 DOI: 10.12968/jowc.2022.31.sup7.s5] [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: 11/11/2022]
Abstract
OBJECTIVE To investigate the role of an adherent soft silicone antimicrobial occlusive foam silver-impregnated dressing for reduction of surgical site infections (SSI) in primary low-transverse caesarean section (1°LTCS) delivery. METHOD Women aged 18-45 years admitted to the labour and delivery or the antepartum unit undergoing a 1°LTCS were recruited. Exclusion criteria included repeat caesarean, vertical skin incision, intrapartum fever and closure with staples. Consented participants delivered by scheduled or unscheduled 1°LTCS received the silver-impregnated dressing. Those who declined to participate and were delivered by scheduled or unscheduled caesarean received a standard gauze with tape dressing (controls). Surgical preparation and preoperative antibiotics were administered as per hospital policy. RESULTS A total of 362 participants were consented for use of the silver-impregnated dressing, with 190 participants undergoing 1°LTCS, of whom 185 were included in the final analysis. Of those who declined to participate, 190 ultimately underwent 1°LTCS during the same time period. Cases and controls were similar in demographics, body mass index, diabetes status, labour and procedure length, and tobacco use. The overall incidence of SSI was 3.7%. A 50% reduction in incidence of SSI was observed in the silver-impregnated dressing group compared with control group (2.7% versus 4.7%, respectively), but this was not statistically significant (p=0.08; odds ratio 0.55; 95% confidence interval: 0.18-1.67). CONCLUSION Among women undergoing 1°LTCS with subcuticular closure of a transverse incision, use of a silver-impregnated dressing reduced the rate of SSI by >50% but was not statistically significant.
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Affiliation(s)
- Jean Ricci Goodman
- Department of Obstetrics, Gynecology, and Women's Health, University of Missouri, Columbia, Missouri, US
| | - Ramon Durazo-Arvizu
- Department of Biostatistics, Loyola University Chicago Health Sciences Division, Maywood, Illinois, US
| | - Sereen Nashif
- Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, Illinois, US
| | - Lindsey A McAlarnen
- Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, Illinois, US
| | - Sarah A Wagner
- Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, Illinois, US
| | - Ann K Lal
- Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, Illinois, US
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Miner SA, Lee J, Protzman NM, Brigido SA. The effect of a silver hydrogel sheet dressing on postsurgical incision healing after foot and ankle surgery. Scars Burn Heal 2022; 8:20595131221122303. [PMID: 36200048 PMCID: PMC9527997 DOI: 10.1177/20595131221122303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction Silver hydrogel dressings are antimicrobial dressings with the potential to aid post-surgical healing. The purpose of this study is to evaluate the effects of a silver hydrogel dressing on postoperative scarring and complications. Methods 40 foot and ankle patients (48.43 ± 16.82 years) were included in the study with 20 patients in each group. Postoperatively, the treatment group was treated with a silver hydrogel sheet dressing, and the control group was treated with a standard petroleum-based dressing. Follow-up was performed at two, six, and 12 weeks. Postoperative scarring and complications were evaluated and compared between groups. Scarring was evaluated using the Patient and Observer Scar Assessment Scale (POSAS). Scar length and width were measured using digital calipers and used to compute scar area. Results The treatment group demonstrated statistically significant improvements in the POSAS observer score and observer opinion at six and 12 weeks (p < 0.001). Additionally, patient reported pain was significantly lower for the treatment group than the control group at 12 weeks (p < 0.001). Patient reported itch declined across time for both groups (p < 0.001) with significantly less itching reported by the treatment group (p = 0.027). Scar area was also significantly lower for the treatment group than the control group at six weeks and 12 weeks (p ≤ 0.002). Neither group experienced any postoperative complications. Conclusion These results suggest that the inherent properties of the silver hydrogel dressing may improve postsurgical scarring. Lay Summary Surgical incisions result in scar, which can present both cosmetic and rehabilitation concerns after foot or ankle surgery. It is standard to use a petroleum-based dressing on incisions after surgery, however, advancements in incisional dressings have been made over the past 20 years. One such advancement is silver-impregnated hydrogel sheet dressings which have been shown to maintain a moist wound environment conducive to healing, while decreasing the chance of infection through its antimicrobial properties. This paper evaluates scar healing after foot or ankle surgery in patients treated with either the standard petroleum-based dressing, or the silver hydrogel sheet dressing. Patients who were treated with the silver hydrogel dressing had less itching and pain, as well as a smaller scar area than patients in the standard dressing group. Therefore, our results suggest that the silver hydrogel dressing may improve scarring after surgery.
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Affiliation(s)
- Samantha A Miner
- Coordinated Health-Lehigh Valley Health Network, Bethlehem, PA, USA
| | - Jonathan Lee
- Dartmouth-Hitchcock Medical Center, Manchester, NH, USA
| | | | - Stephen A Brigido
- Foot and Ankle Reconstruction, Coordinated Health-Lehigh Valley Health Network, Bethlehem, PA, USA
- Foot and Ankle Surgery, Coordinated Health-Lehigh Valley Health Network, Bethlehem, PA, USA
- Clinical Sciences Department, The Commonwealth Medical College, Scranton, PA, USA
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Ohge H, Mayumi T, Haji S, Kitagawa Y, Kobayashi M, Kobayashi M, Mizuguchi T, Mohri Y, Sakamoto F, Shimizu J, Suzuki K, Uchino M, Yamashita C, Yoshida M, Hirata K, Sumiyama Y, Kusachi S. The Japan Society for Surgical Infection: guidelines for the prevention, detection, and management of gastroenterological surgical site infection, 2018. Surg Today 2021; 51:1-31. [PMID: 33320283 PMCID: PMC7788056 DOI: 10.1007/s00595-020-02181-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND The guidelines for the prevention, detection, and management of gastroenterological surgical site infections (SSIs) were published in Japanese by the Japan Society for Surgical Infection in 2018. This is a summary of these guidelines for medical professionals worldwide. METHODS We conducted a systematic review and comprehensive evaluation of the evidence for diagnosis and treatment of gastroenterological SSIs, based on the concepts of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The strength of recommendations was graded and voted using the Delphi method and the nominal group technique. Modifications were made to the guidelines in response to feedback from the general public and relevant medical societies. RESULTS There were 44 questions prepared in seven subject areas, for which 51 recommendations were made. The seven subject areas were: definition and etiology, diagnosis, preoperative management, prophylactic antibiotics, intraoperative management, perioperative management, and wound management. According to the GRADE system, we evaluated the body of evidence for each clinical question. Based on the results of the meta-analysis, recommendations were graded using the Delphi method to generate useful information. The final version of the recommendations was published in 2018, in Japanese. CONCLUSIONS The Japanese Guidelines for the prevention, detection, and management of gastroenterological SSI were published in 2018 to provide useful information for clinicians and improve the clinical outcome of patients.
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Affiliation(s)
- Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan.
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Seiji Haji
- Department of Surgery, Soseikai General Hospital, Kyoto, Japan
| | - Yuichi Kitagawa
- Department of Infection Control, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Masahiro Kobayashi
- Laboratory of Clinical Pharmacokinetics, School of Pharmacy, Kitasato University, Tokyo, Japan
| | - Motomu Kobayashi
- Perioperative Management Center, Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Toru Mizuguchi
- Division of Surgical Science, Department of Nursing, Sapporo Medical University, Sapporo, Japan
| | - Yasuhiko Mohri
- Department of Surgery, Mie Prefectural General Medical Center, Mie, Japan
| | - Fumie Sakamoto
- Infection Control Division, Quality Improvement Center, St. Luke's International Hospital, Tokyo, Japan
| | - Junzo Shimizu
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Katsunori Suzuki
- Division of Infection Control and Prevention, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Motoi Uchino
- Division of Inflammatory Bowel Disease Surgery, Department of Gastroenterological Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Chizuru Yamashita
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Aichi, Japan
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | | | | | - Shinya Kusachi
- Department of Surgery, Tohokamagaya Hospital, Chiba, Japan
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Assessment of the Risk and Economic Burden of Surgical Site Infection Following Colorectal Surgery Using a US Longitudinal Database: Is There a Role for Innovative Antimicrobial Wound Closure Technology to Reduce the Risk of Infection? Dis Colon Rectum 2020; 63:1628-1638. [PMID: 33109910 PMCID: PMC7774813 DOI: 10.1097/dcr.0000000000001799] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Colorectal surgical procedures place substantial burden on health care systems because of the high complication risk, of surgical site infections in particular. The risk of surgical site infection after colorectal surgery is one of the highest of any surgical specialty. OBJECTIVE The purpose of this study was to determine the incidence, cost of infections after colorectal surgery, and potential economic benefit of using antimicrobial wound closure to improve patient outcomes. DESIGN Retrospective observational cohort analysis and probabilistic cost analysis were performed. SETTINGS The analysis utilized a database for colorectal patients in the United States between 2014 and 2018. PATIENTS A total of 107,665 patients who underwent colorectal surgery were included in the analysis. MAIN OUTCOME MEASURES Rate of infection was together with identified between 3 and 180 days postoperatively, infection risk factors, infection costs over 24 months postoperatively by payer type (commercial payers and Medicare), and potential costs avoided per patient by using an evidence-based innovative wound closure technology. RESULTS Surgical site infections were diagnosed postoperatively in 23.9% of patients (4.0% superficial incisional and 19.9% deep incisional/organ space). Risk factors significantly increased risk of deep incisional/organ-space infection and included several patient comorbidities, age, payer type, and admission type. After 12 months, adjusted increased costs associated with infections ranged from $36,429 to $144,809 for commercial payers and $17,551 to $102,280 for Medicare, depending on surgical site infection type. Adjusted incremental costs continued to increase over a 24-month study period for both payers. Use of antimicrobial wound closure for colorectal surgery is projected to significantly reduce median payer costs by $809 to $1170 per patient compared with traditional wound closure. LIMITATIONS The inherent biases associated with retrospective databases limited this study. CONCLUSIONS Surgical site infection cost burden was found to be higher than previously reported, with payer costs escalating over a 24-month postoperative period. Cost analysis results for adopting antimicrobial wound closure aligns with previous evidence-based studies, suggesting a fiscal benefit for its use as a component of a comprehensive evidence-based surgical care bundle for reducing the risk of infection. See Video Abstract at http://links.lww.com/DCR/B358. EVALUACIÓN DEL RIESGO Y LA CARGA ECONÓMICA DE LA INFECCIÓN DEL SITIO QUIRÚRGICO DESPUÉS DE UNA CIRUGÍA COLORRECTAL UTILIZANDO UNA BASE DE DATOS LONGITUDINAL DE EE.UU.: ¿EXISTE UN PAPEL PARA LA TECNOLOGÍA INNOVADORA DE CIERRE DE HERIDAS ANTIMICROBIANAS PARA REDUCIR EL RIESGO DE INFECCIÓN?: Los procedimientos quirúrgicos colorrectales suponen una carga considerable para los sistemas de salud debido al alto riesgo de complicaciones, particularmente las infecciones del sitio quirúrgico. El riesgo de infección posoperatoria del sitio quirúrgico colorrectal es uno de los más altos de cualquier especialidad quirúrgica.El propósito de este estudio fue determinar la incidencia, el costo de las infecciones después de la cirugía colorrectal y el beneficio económico potencial del uso del cierre de la herida con antimicrobianos para mejorar los resultados de los pacientes.Análisis retrospectivo de cohorte observacional y análisis de costo probabilístico.El análisis utilizó la base de datos para pacientes colorrectales en los Estados Unidos entre 2014 y 2018.Un total de 107,665 pacientes sometidos a cirugía colorrectal.Se identificó una tasa de infección entre 3 y 180 días después de la operación, los factores de riesgo de infección, los costos de infección durante 24 meses posteriores a la operación por tipo de pagador (pagadores comerciales y Medicare), y los costos potenciales evitados por paciente utilizando una tecnología innovadora de cierre de heridas basada en evidencias.Infecciones del sitio quirúrgico, diagnosticadas postoperatoriamente en el 23,9% de los pacientes (4,0% incisional superficial y 19,9% incisional profunda / espacio orgánico). Los factores de riesgo aumentaron significativamente el riesgo de infección profunda por incisión / espacio orgánico e incluyeron comorbilidades selectivas del paciente, edad, tipo de pagador y tipo de admisión. Después de 12 meses, el aumento de los costos asociados con las infecciones varió de $ 36,429 a $ 144,809 para los pagadores comerciales y de $ 17,551 a $ 102,280 para Medicare, según el tipo de infección del sitio quirúrgico. Los costos incrementales ajustados continuaron aumentando durante un período de estudio de 24 meses para ambos pagadores. Se prevé que el uso del cierre antimicrobiano de la herida para la cirugía colorrectal reducirá significativamente los costos medios del pagador en $ 809- $ 1,170 por paciente en comparación con el cierre tradicional de la herida.Los sesgos inherentes asociados a las bases de datos retrospectivas limitaron este estudio.Se encontró que la carga del costo de la infección del sitio quirúrgico es mayor que la reportada previamente, y los costos del pagador aumentaron durante un período postoperatorio de 24 meses. Los resultados del análisis de costos para la adopción del cierre de heridas antimicrobianas se alinean con estudios previos basados en evidencia, lo que sugiere un beneficio fiscal para su uso como componente de un paquete integral de atención quirúrgica basada en evidencia para reducir el riesgo de infección. Consulte Video Resumen en http://links.lww.com/DCR/B358.
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Ramot Y, Nedvetzki S, Rosenfeld S, Rousselle SD, Nyska A, Emanuel N. D-PLEX 100 in an Abdominal Surgery Incision Model in Miniature Swine: Safety Study. Toxicol Pathol 2020; 48:677-685. [PMID: 32525456 DOI: 10.1177/0192623320928902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Surgical site infections (SSIs) are a common surgical-related complication. To avoid these complications, a new biodegradable polymer-lipid encapsulation matrix that provides controlled release of doxycycline (doxycycline/polymer-lipid encapsulation matrix [D-PLEX]) has been developed. The aim of this comprehensive study was to evaluate the potential safety of D-PLEX100 in abdominal surgical site. D-PLEX100 was administered into incisions of abdominal surgical site in Yucatan miniature swine, which were followed for up to 6 months and compared to sham-control swine. The D-PLEX100 mass did not migrate from the incisional site, and there was no evidence for systemic toxicity or other safety concerns. Surgical incision sites, including the peritoneal surface, were fully healed at 6 months in all animals. Most of the D-PLEX100 mass was absorbed during the first 3 months, and by 6 months, D-PLEX100 was fully absorbed. Toxicokinetic evaluation revealed that doxycycline concentrations were evident at 30 minutes and persisted to 8 days (71 mg/kg) or at least 15 days (284 mg/kg) and were no longer present in plasma by day 29. This study supports the safety of D-PLEX100 and its favorable degradability profile. A clinical study is being performed to assess the safety and the efficacy of D-PLEX100 to prevent human abdominal SSIs.
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Affiliation(s)
- Yuval Ramot
- Hadassah Medical Center, Hebrew University of Jerusalem, the Faculty of Medicine, Jerusalem, Israel
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Mana TSC, Donskey C, Carty N, Perry L, Leaper D, Edmiston CE. Preliminary analysis of the antimicrobial activity of a postoperative wound dressing containing chlorhexidine gluconate against methicillin-resistant Staphylococcus aureus in an in vivo porcine incisional wound model. Am J Infect Control 2019; 47:1048-1052. [PMID: 31277998 DOI: 10.1016/j.ajic.2019.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Surgical site infection is a major postoperative complication after surgical procedures. The effectiveness of postoperative antimicrobial dressings in reducing surgical site infections is unclear and limited information is available on the efficacy of chlorhexidine gluconate (CHG)-impregnated postoperative dressings. METHODS A pilot study was conducted to examine the efficacy of an innovative CHG-impregnated postoperative dressing in reducing the burden of methicillin-resistant Staphylococcus aureus (MRSA) in an in vivo porcine, incisional-wound model. Sutured incisional wounds were contaminated with MRSA and then covered with a CHG wound dressing, a placebo control, or a nonantimicrobial gauze. The surviving MRSA population was quantitatively cultured 3 days postprocedure. RESULTS MRSA was not recovered from any of the 8 wounds that were treated with the CHG dressing (limit of detection, approximately 1.7 log10 colony-forming units [cfu]/g tissue). In contrast, the average microbial recovery from wounds treated with the placebo dressing was 4.2 log10 cfu/g and the average microbial recovery from wounds treated with the gauze dressing was 3.2 log10 cfu/g. CONCLUSIONS An innovative CHG dressing provided significant antimicrobial activity against MRSA contaminating a surgical wound in a porcine, incisional-wound model. Future clinical studies are needed to assess the efficacy of the CHG dressing to reduce the bacterial burden in postoperative wounds of surgical patients.
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Khansa I, Schoenbrunner AR, Kraft CT, Janis JE. Silver in Wound Care-Friend or Foe?: A Comprehensive Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2390. [PMID: 31592393 PMCID: PMC6756674 DOI: 10.1097/gox.0000000000002390] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/19/2019] [Indexed: 12/12/2022]
Abstract
Due to its strong antimicrobial activity, silver is a commonly used adjunct in wound care. However, it also has the potential to impair healing by exerting toxic effects on keratinocytes and fibroblasts. The published literature on the use of silver in wound care is very heterogeneous, making it difficult to generate useful treatment guidelines. METHODS A search of high-quality studies on the use of silver in wound care was performed on PubMed. A detailed qualitative analysis of published articles was performed to evaluate the evidence for the use of silver in infected wounds, clean wounds, burns, and over closed surgical incisions. RESULTS Fifty-nine studies were included in this qualitative analysis. We found that, overall, the quality of the published research on silver is poor. While there is some evidence for short-term use of dressings containing nanocrystalline silver in infected wounds, the use of silver-containing dressings in clean wounds and over closed surgical incisions is not indicated. Negative-pressure wound therapy accelerates the healing of contaminated wounds, especially when silver is used as an adjunct. For burns, silver sulfadiazine slows healing and should not be used. Instead, nanocrystalline silver, or alternatives such as octenidine and polyhexanide, lead to less infection and faster healing. CONCLUSIONS In infected wounds, silver is beneficial for the first few days/weeks, after which nonsilver dressings should be used instead. For clean wounds and closed surgical incisions, silver confers no benefit. The ideal silver formulations are nanocrystalline silver and silver-coated polyurethane sponge for negative-pressure wound therapy. Silver sulfadiazine impairs wound healing. Proper use of silver-containing dressings is essential to optimize wound healing.
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Affiliation(s)
- Ibrahim Khansa
- From the Division of Plastic and Reconstructive Surgery, Nationwide Children’s Hospital, Columbus, Ohio
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Anna R. Schoenbrunner
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Casey T. Kraft
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jeffrey E. Janis
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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15
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Abunimer A, Fogel S. A Protocol to Decrease Surgical Site Infection Rates in Colorectal Surgical Procedures. Am Surg 2018. [DOI: 10.1177/000313481808400926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ayman Abunimer
- Virginia Tech Carilion School of Medicine Roanoke, Virginia
| | - Sandy Fogel
- Virginia Tech Carilion School of Medicine Roanoke, Virginia
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16
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Li HZ, Zhang L, Chen JX, Zheng Y, Zhu XN. Silver-containing dressing for surgical site infection in clean and clean-contaminated operations: a systematic review and meta-analysis of randomized controlled trials. J Surg Res 2017; 215:98-107. [PMID: 28688669 DOI: 10.1016/j.jss.2017.03.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/27/2017] [Accepted: 03/24/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Silver-containing dressings for the prevention of surgical site infections (SSIs) remained controversial, and accumulating evidence was lacking, so a meta-analysis was conducted to systematically assess the effectiveness and safety of silver-containing dressings for clean and clean-contaminated surgical incisions. METHODS Pubmed, Embase, and the Cochrane Library were searched from the inception to February 2016 for randomized controlled trials (RCTs), which explored silver-containing dressings for the prevention of SSIs in clean and clean-contaminated operations. Relative risk (RR) with 95% confidence interval (CI) was pooled using random effects model. Predefined subgroup analyses, sensitivity analyses, and influence analyses were further undertaken. RESULTS Nine RCTs totaling 2196 patients (1141 in silver-containing group and 1055 in control group) were included. Silver-containing dressings did not effectively prevent the incidence of SSIs (9 RCTs; RR: 0.92; 95% CI: 0.66-1.29; I2 = 40%), superficial SSIs (5 RCTs; RR: 0.67; 95% CI: 0.36-1.24; I2 = 36%), and deep SSIs (5 RCTs; RR: 0.78; 95% CI: 0.41-1.49; I2 = 0). Subgroup analyses, sensitivity analyses, and influence analyses confirmed the robustness of the pooled estimate. CONCLUSIONS The current available evidence indicated that silver-containing dressing as compared with silver-free dressing was not associated with lower incidence of SSIs. Considering the quality of evidence ranking very low, further studies with higher quality should be warranted.
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Affiliation(s)
- Hui-Zi Li
- Department of General Surgery, The Fourth Affiliated Hospital of NanChang University, Nanchang, Jiangxi, China
| | - Lei Zhang
- Department of Biliary-Pancreatic Surgery, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics, Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jia-Xi Chen
- Department of General Surgery, The Fourth Affiliated Hospital of NanChang University, Nanchang, Jiangxi, China
| | - Yang Zheng
- Department of General Surgery, The Fourth Affiliated Hospital of NanChang University, Nanchang, Jiangxi, China
| | - Xiang-Nan Zhu
- Department of General Surgery, The Fourth Affiliated Hospital of NanChang University, Nanchang, Jiangxi, China.
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Ploegmakers IBM, Olde Damink SWM, Breukink SO. Alternatives to antibiotics for prevention of surgical infection. Br J Surg 2017; 104:e24-e33. [PMID: 28121034 DOI: 10.1002/bjs.10426] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 09/29/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Surgical-site infection (SSI) is still the second most common healthcare-associated infection, after respiratory tract infection. SSIs are associated with higher morbidity and mortality rates, and result in enormous healthcare costs. In the past decade, several guidelines have been developed that aim to reduce the incidence of SSI. Unfortunately, there is no consensus amongst the guidelines, and some are already outdated. This review discusses the recent literature regarding alternatives to antibiotics for prevention of SSI. METHODS A literature search of PubMed/MEDLINE was performed to retrieve data on the prevention of SSI. The focus was on literature published in the past decade. RESULTS Prevention of SSI can be divided into preoperative, perioperative and postoperative measures. Preoperative measures consist of showering, surgical scrubbing and cleansing of the operation area with antiseptics. Perioperative factors can be subdivided as: environmental factors, such as surgical attire; patient-related factors, such as plasma glucose control; and surgical factors, such as the duration and invasiveness of surgery. Postoperative measures consist mainly of wound care. CONCLUSION There is a general lack of evidence on the preventive effectiveness of perioperative measures to reduce the incidence of SSI. Most measures are based on common practice and perceived effectiveness. The lack of clinical evidence, together with the stability of the high incidence of SSI (10 per cent for colorectal procedures) in recent decades, highlights the need for future research.
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Affiliation(s)
- I B M Ploegmakers
- Department of Surgery, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - S W M Olde Damink
- Department of Surgery, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Royal Free Hospital, University College London, London, UK
| | - S O Breukink
- Department of Surgery, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
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Bevilacqua MP, Huang DJ, Wall BD, Lane SJ, Edwards CK, Hanson JA, Benitez D, Solomkin JS, Deming TJ. Amino Acid Block Copolymers with Broad Antimicrobial Activity and Barrier Properties. Macromol Biosci 2017; 17. [DOI: 10.1002/mabi.201600492] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/14/2017] [Indexed: 01/05/2023]
Affiliation(s)
| | - Daniel J. Huang
- Amicrobe, Inc. 3142 Tiger Run Court #101 Carlsbad CA 92010 USA
| | - Brian D. Wall
- Amicrobe, Inc. 3142 Tiger Run Court #101 Carlsbad CA 92010 USA
| | - Shalyn J. Lane
- Amicrobe, Inc. 3142 Tiger Run Court #101 Carlsbad CA 92010 USA
| | - Carl K. Edwards
- Amicrobe, Inc. 3142 Tiger Run Court #101 Carlsbad CA 92010 USA
| | | | - Diego Benitez
- Amicrobe, Inc. 3142 Tiger Run Court #101 Carlsbad CA 92010 USA
| | | | - Timothy J. Deming
- University of California, Los Angeles Bioengineering Department Chemistry and Biochemistry Department 5121, Engineering V Los Angeles CA 90095 USA
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Dumville JC, Gray TA, Walter CJ, Sharp CA, Page T, Macefield R, Blencowe N, Milne TKG, Reeves BC, Blazeby J. Dressings for the prevention of surgical site infection. Cochrane Database Syst Rev 2016; 12:CD003091. [PMID: 27996083 PMCID: PMC6464019 DOI: 10.1002/14651858.cd003091.pub4] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Surgical wounds (incisions) heal by primary intention when the wound edges are brought together and secured, often with sutures, staples, or clips. Wound dressings applied after wound closure may provide physical support, protection and absorb exudate. There are many different types of wound dressings available and wounds can also be left uncovered (exposed). Surgical site infection (SSI) is a common complication of wounds and this may be associated with using (or not using) dressings, or different types of dressing. OBJECTIVES To assess the effects of wound dressings compared with no wound dressings, and the effects of alternative wound dressings, in preventing SSIs in surgical wounds healing by primary intention. SEARCH METHODS We searched the following databases: the Cochrane Wounds Specialised Register (searched 19 September 2016); the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library 2016, Issue 8); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations, MEDLINE Daily and Epub Ahead of Print; 1946 to 19 September 2016); Ovid Embase (1974 to 19 September 2016); EBSCO CINAHL Plus (1937 to 19 September 2016).There were no restrictions based on language, date of publication or study setting. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing wound dressings with wound exposure (no dressing) or alternative wound dressings for the postoperative management of surgical wounds healing by primary intention. DATA COLLECTION AND ANALYSIS Two review authors performed study selection, 'Risk of bias' assessment and data extraction independently. MAIN RESULTS We included 29 trials (5718 participants). All studies except one were at an unclear or high risk of bias. Studies were small, reported low numbers of SSI events and were often not clearly reported. There were 16 trials that included people with wounds resulting from surgical procedures with a 'clean' classification, five trials that included people undergoing what was considered 'clean/contaminated' surgery, with the remaining studies including people undergoing a variety of surgical procedures with different contamination classifications. Four trials compared wound dressings with no wound dressing (wound exposure); the remaining 25 studies compared alternative dressing types, with the majority comparing a basic wound contact dressing with film dressings, silver dressings or hydrocolloid dressings. The review contains 11 comparisons in total. PRIMARY OUTCOME SSIIt is uncertain whether wound exposure or any dressing reduces or increases the risk of SSI compared with alternative options investigated: we assessed the certainty of evidence as very low for most comparisons (and low for others), with downgrading (according to GRADE criteria) largely due to risk of bias and imprecision. We summarise the results of comparisons with meta-analysed data below:- film dressings compared with basic wound contact dressings following clean surgery (RR 1.34, 95% CI 0.70 to 2.55), very low certainty evidence downgraded once for risk of bias and twice for imprecision.- hydrocolloid dressings compared with basic wound contact dressings following clean surgery (RR 0.91, 95% CI 0.30 to 2.78), very low certainty evidence downgraded once for risk of bias and twice for imprecision.- hydrocolloid dressings compared with basic wound contact dressings following potentially contaminated surgery (RR 0.57, 95% CI 0.22 to 1.51), very low certainty evidence downgraded twice for risk of bias and twice for imprecision.- silver-containing dressings compared with basic wound contact dressings following clean surgery (RR 1.11, 95% CI 0.47 to 2.62), very low certainty evidence downgraded once for risk of bias and twice for imprecision.- silver-containing dressings compared with basic wound contact dressings following potentially contaminated surgery (RR 0.83, 95% CI 0.51 to 1.37), very low certainty evidence downgraded twice for risk of bias and twice for imprecision. Secondary outcomesThere was limited and low or very low certainty evidence on secondary outcomes such as scarring, acceptability of dressing and ease of removal, and uncertainty whether wound dressings influenced these outcomes. AUTHORS' CONCLUSIONS It is uncertain whether covering surgical wounds healing by primary intention with wound dressings reduces the risk of SSI, or whether any particular wound dressing is more effective than others in reducing the risk of SSI, improving scarring, reducing pain, improving acceptability to patients, or is easier to remove. Most studies in this review were small and at a high or unclear risk of bias. Based on the current evidence, decision makers may wish to base decisions about how to dress a wound following surgery on dressing costs as well as patient preference.
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Affiliation(s)
- Jo C Dumville
- University of ManchesterDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthManchesterUKM13 9PL
| | - Trish A Gray
- University of ManchesterDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthManchesterUKM13 9PL
| | - Catherine J Walter
- Gloucestershire NHS Foundation TrustColorectal SurgeryCheltenham GeneralSandford RoadCheltenhamUKGL53 7AN
| | - Catherine A Sharp
- The Wound CentrePO Box 3207BlakehurstSydneyNew South WalesAustralia2221
| | - Tamara Page
- Royal Adelaide HospitalLevel 4, Margaret Graham BuildingNorth TerraceAdelaideAustraliaSA5000
- University of AdelaideLevel 3, Eleanor Harrald BuildingNorth TerraceAdelaideAustraliaSA 5000
| | - Rhiannon Macefield
- University of BristolUniversity of Bristol, School of Social and Community MedicineCanynge Hall, 39 Whatley RoadBristolUKBS28 2PS
| | - Natalie Blencowe
- University of BristolUniversity of Bristol, School of Social and Community MedicineCanynge Hall, 39 Whatley RoadBristolUKBS28 2PS
| | - Thomas KG Milne
- University of BristolUniversity of Bristol, School of Social and Community MedicineCanynge Hall, 39 Whatley RoadBristolUKBS28 2PS
| | - Barnaby C Reeves
- University of BristolSchool of Clinical SciencesLevel 7, Bristol Royal InfirmaryMarlborough StreetBristolUKBS2 8HW
| | - Jane Blazeby
- University of BristolBristol Centre for Surgical Research, School of Social & Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
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Love KL. Patient Care Interventions to Reduce the Risk of Surgical Site Infections. AORN J 2016; 104:506-515. [DOI: 10.1016/j.aorn.2016.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 10/04/2016] [Indexed: 01/28/2023]
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21
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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: 476] [Impact Index Per Article: 59.5] [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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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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Oquendo M, Agrawal V, Reyna R, Patel HI, Emran MA, Almond PS. Silver-impregnated hydrofiber dressing followed by delayed surgical closure for management of infants born with giant omphaloceles. J Pediatr Surg 2015; 50:1668-72. [PMID: 26386876 DOI: 10.1016/j.jpedsurg.2015.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 06/16/2015] [Accepted: 06/17/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE We successfully employed silver-impregnated hydrofiber dressing for management of giant omphaloceles (GO) followed by delayed surgical closure. STUDY DESIGN Between 2005 and 2008, eight consecutive GO infants were cared for at Driscoll Children's Hospital. Four patients had additional congenital anomalies including Beckwith-Wiedemann (n = 1), tetralogy of Fallot (n = 1), pulmonary hypoplasia (n = 1), and ruptured omphalocele (n=1). Infants underwent amnion epithelization using a silver-impregnated hydrofiber dressing over the course of several months followed by delayed surgical closure. Mean ± SD of parameters including maternal age, gestational age, infant weight, size of GO, preoperative intubation, preoperative hospitalization, time to epithelization, days to surgical closure, postoperative hospitalization, postoperative intubation and months of follow-up were studied. RESULTS Five patients underwent successful closure, 2 were lost to follow-up and 1 was lost because of withdrawal of support. The maternal age, gestation age and weight of infant were 28 ± 5.3 years, 34 ± 4 weeks and 2.5 ± 0.62 kg, respectively. The GO size was 11 cm in length and 11 cm in width, respectively. Preoperative hospitalization days were 78 ± 74 days. Preoperative intubation was 3.5 ± 3.1 days with 2 neonates requiring tracheostomy and home ventilation owing to additional congenital abnormalities. Time to epithelization was 2.9 ± 0.9 months. Days to surgical closure and postoperative hospitalization were 331 ± 119 days and 5 ± 3.4 days, respectively. Average follow-up was 37 ± 27 months. No treatment associated morbidities are noted. CONCLUSIONS Silver-impregnated hydrofiber mediated epithelization of GO followed by delayed surgical closure is safe for management of infants.
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Affiliation(s)
- Marcial Oquendo
- Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Vaidehi Agrawal
- Department of Surgery, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Roxana Reyna
- Nursing Resources, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Haroon I Patel
- Department of Surgery, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Mohammad A Emran
- Department of Surgery, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - P Stephen Almond
- Department of Surgery, Driscoll Children's Hospital, Corpus Christi, TX, USA.
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Assadian O, Arnoldo B, Purdue G, Burris A, Skrinjar E, Duschek N, Leaper DJ. A prospective, randomised study of a novel transforming methacrylate dressing compared with a silver-containing sodium carboxymethylcellulose dressing on partial-thickness skin graft donor sites in burn patients. Int Wound J 2015; 12:351-6. [PMID: 23919667 PMCID: PMC7950751 DOI: 10.1111/iwj.12136] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 07/02/2013] [Accepted: 07/08/2013] [Indexed: 12/30/2022] Open
Abstract
This prospective, randomised study compares a new transforming methacrylate dressing (TMD) with a silver-containing carboxymethylcellulose dressing (CMC-Ag) after application to split-thickness skin graft (STSG) donor sites. This was an unblinded, non-inferiority, between-patient, comparison study that involved patients admitted to a single-centre burn unit who required two skin graft donor sites. Each patient's donor sites were covered immediately after surgery: one donor site with TMD and the other with CMC-Ag. The donor sites were evaluated until healing or until 24 days post-application, whichever came first. Study endpoints were time to healing, daily pain scores, number of dressing changes, patient comfort and physicians' and patients' willingness to use the dressings in the future. Nineteen patients had both the dressings applied. No statistically significant difference was noted in time to healing between the two dressings (14·2 days using TMD compared with 13·2 days using CMC-Ag). When pain scores were compared, TMD resulted in statistically significantly less pain at three different time periods (2-5 days, 6-10 days and 11-15 days; P < 0·001 at all time periods). Patients also reported greater comfort with TMD (P < 0·001). Users rated TMD as being less easy to use because of the time and technique required for application. Reductions in pain and increased patient comfort with the use of the TMD dressing, compared with CMC-Ag, were seen as clinical benefits as these are the major issues in donor site management.
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Affiliation(s)
- Ojan Assadian
- Department for Hospital Hygiene, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Brett Arnoldo
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Gary Purdue
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Agnes Burris
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Edda Skrinjar
- Department for Vascular and Endovascular Surgery, Wilhelminen-Hospital, Vienna, Austria
| | - Nikolaus Duschek
- Department for Vascular and Endovascular Surgery, Wilhelminen-Hospital, Vienna, Austria
| | - David J Leaper
- Department of Surgery, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
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Agrawal V, Almond PS, Reyna R, Emran MA. Successful three stage repair of a large congenital abdominal region defect. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Ruiz-Tovar J, Llavero C, Morales V, Gamallo C. Total Occlusive Ionic Silver-Containing Dressing vs Mupirocin Ointment Application vs Conventional Dressing in Elective Colorectal Surgery: Effect on Incisional Surgical Site Infection. J Am Coll Surg 2015. [PMID: 26206641 DOI: 10.1016/j.jamcollsurg.2015.04.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Several pre- and intraoperative factors have been associated with incisional surgical site infection (SSI), but little is known about the influence of postoperative wound care and especially, the use of different dressings on incisional SSI. The aim of this study was to compare 3 methods of wound dressings (conventional dressing, silver-containing dressing, and mupirocin ointment dressing) for their ability to prevent SSI, as measured by SSI rates, in patients with colorectal cancer undergoing elective open surgery. STUDY DESIGN A prospective, randomized study was performed. Inclusion criteria were diagnosis of colorectal neoplasms and plans to undergo elective surgery with curative aims. Patients were randomized using a 1:1:1 allocation into 3 groups: patients receiving an ionic silver-containing dressing (ISD) (group 1), a mupirocin ointment application (MOA) (group 2), and a conventional dressing (group 3 or standard dressing). The primary outcomes variable was occurrence of incisional SSI. Follow-up was 30 days postoperatively. RESULTS A total of 147 patients were included, 49 in each group. Incisional SSI occurred in 9 patients (18.4%) in the ISD group, 2 (4.1%) in the MOA group, and 10 (20.4%) in the standard dressing group (p = 0.028). Adjusting for multiple comparisons, there were no significant differences between ISD and standard dressing groups; a significant difference was observed between ISD and MOA (relative risk [RR] 4.5; 95% CI (1.1 to 19.8); p = 0.046) and between the standard group and the MOA group (RR 5; 95% CI (1.2 to 21.7); p = 0.031). CONCLUSIONS Topical application of mupirocin ointment achieves better results for the prevention of SSI than ionic silver-containing dressing or standard dressing in patients undergoing elective open colorectal surgery.
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Affiliation(s)
| | | | - Vicente Morales
- Department of Surgery, University Hospital Ramon y Cajal, Madrid, Spain
| | - Carlos Gamallo
- Department of Pathology, Universidad Autónoma de Madrid, Madrid, Spain
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A randomized double-blind clinical trial of a continuous 96-hour levobupivacaine infiltration after open or laparoscopic colorectal surgery for postoperative pain management--including clinically important changes in protein binding. Ther Drug Monit 2015; 36:202-10. [PMID: 24089075 DOI: 10.1097/ftd.0b013e3182a3772e] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Continuous local anesthetic infiltration has been used for pain management after open colorectal surgery. However, its application to patients undergoing laparoscopic colorectal surgery has not been examined. The aim of this prospective, randomized, double-blind, placebo-controlled clinical trial was to study the use of a commercial infiltration device in patients undergoing open or laparoscopic colorectal surgery, along with plasma concentrations of levobupivacaine, its acute-phase binding protein (alpha-1 acid glycoprotein, AAG), and the stress marker, cortisol. METHODS Eligible patients were randomized (2:1) to receive a continuous infiltration of either levobupivacaine or placebo using a commercial device (ON-Q PainBuster) inserted in the preperitoneal layer at the end of surgery. Blood was sampled for determination of levobupivacaine and AAG and cortisol concentrations. Other outcomes measured were pain scores, morbidity and mortality, time to bowel movement, mobilization, and length of hospitalization. RESULTS In patients having open surgery, the levobupivacaine treatment showed a trend toward reduced total opioid consumption. No patients reported adverse effects attributable to levobupivacaine, despite 11 patients having concentrations at some time(s) during the 96-hour infiltration of up to 5.5 mg/L exceeding a putative toxicity threshold of 2.7 mg/L. AAG concentrations measured postsurgery increased by a mean of 55% (P < 0.001) at 48 hours. Cortisol concentrations also increased significantly by a mean of 191% at 1 hour. CONCLUSIONS Continuous local anesthetic infiltration may be more beneficial in open surgery. The threshold for adverse effects from highly bound local anesthetic drugs established in healthy volunteers is of limited usefulness in clinical scenarios in which AAG concentration increases in response to surgical stress. Hence, there is scope to adopt higher doses to enhance therapeutic benefit.
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Abboud EC, Settle JC, Legare TB, Marcet JE, Barillo DJ, Sanchez JE. Silver-based dressings for the reduction of surgical site infection: Review of current experience and recommendation for future studies. Burns 2014; 40 Suppl 1:S30-9. [DOI: 10.1016/j.burns.2014.09.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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When antibiotics can be avoided in skin inflammation and bacterial colonization: a review of topical treatments. Curr Opin Infect Dis 2014; 27:125-9. [PMID: 24514163 DOI: 10.1097/qco.0000000000000044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review looks at the recent evidence on the safety, toxicity, microbiology and the prevention and management of acute and chronic wound infections with regard to antiseptics and antiseptic wound dressings. It is timely and relevant because of the global concerns of antimicrobial resistance and the need to address the inappropriate use of antimicrobials in the healthcare setting. RECENT FINDINGS There have been a number of recent Cochrane reviews that have concluded that there is little evidence to delineate clinical outcomes between antiseptics and antiseptic dressings. Published in-vitro evidence offers some new techniques and evaluates some new dressings and antiseptics. There are no economic evaluations of antiseptics and antiseptic dressings. SUMMARY Better clinical trials on the effectiveness and cost-effectiveness of wound dressings are needed to ensure evidence-based guidance is developed for optimizing the treatment of patients. It is surprising that with the paucity of evidence of clinical effectiveness, healthcare organizations continue to spend considerable resources on poorly evaluated topical wound products.
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Ozaki CK, Hamdan AD, Barshes NR, Wyers M, Hevelone ND, Belkin M, Nguyen LL. Prospective, randomized, multi-institutional clinical trial of a silver alginate dressing to reduce lower extremity vascular surgery wound complications. J Vasc Surg 2014; 61:419-427.e1. [PMID: 25175629 DOI: 10.1016/j.jvs.2014.07.034] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 07/22/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Wound complications negatively affect outcomes of lower extremity arterial reconstruction. By way of an investigator initiated clinical trial, we tested the hypothesis that a silver-eluting alginate topical surgical dressing would lower wound complication rates in patients undergoing open arterial procedures in the lower extremity. METHODS The study block-randomized 500 patients at three institutions to standard gauze or silver alginate dressings placed over incisions after leg arterial surgery. This original operating room dressing remained until gross soiling, clinical need to remove, or postoperative day 3, whichever was first. Subsequent care was at the provider's discretion. The primary end point was 30-day wound complication incidence generally based on National Surgical Quality Improvement Program guidelines. Demographic, clinical, quality of life, and economic end points were also collected. Wound closure was at the surgeon's discretion. RESULTS Participants (72% male) were 84% white, 45% were diabetic, 41% had critical limb ischemia, and 32% had claudication (with aneurysm, bypass revision, other). The overall 30-day wound complication incidence was 30%, with superficial surgical site infection as the most common. In intent-to-treat analysis, silver alginate had no effect on wound complications. Multivariable analysis showed that Coumadin (Bristol-Myers Squibb, Princeton, NJ; odds ratio [OR], 1.72; 95% confidence interval [CI], 1.03-2.87; P = .03), higher body mass index (OR, 1.05; 95% CI, 1.01-1.09; P = .01), and the use of no conduit/material (OR, 0.12; 95% CI, 0.82-3.59; P < .001) were independently associated with wound complications. CONCLUSIONS The incidence of wound complications remains high in contemporary open lower extremity arterial surgery. Under the study conditions, a silver-eluting alginate dressing showed no effect on the incidence of wound complications.
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Affiliation(s)
- C Keith Ozaki
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
| | - Allen D Hamdan
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Neal R Barshes
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Mark Wyers
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Nathanael D Hevelone
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Michael Belkin
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Louis L Nguyen
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
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Galli MM, Protzman NM, Brigido SA. Utilization of silver hydrogel sheet dressing on postsurgical incisions: a pilot study in foot and ankle surgery. Foot Ankle Spec 2013; 6:422-33. [PMID: 24154992 DOI: 10.1177/1938640013507108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Silver hydrogel dressings are antimicrobial, nonadherent, and have an absorptive capacity many times their weight. Fifty-nine (49.44 ± 16.85 years) foot and ankle patients with incisions >1 cm were prospectively enrolled to compare infection, scarring, and complication rates between the postoperative use of a silver hydrogel sheet (SHS) dressing and a standard petroleum-based (P) dressing. Overall, there were 5 (8.47%) infections; 4 (6.78%) superficial and 1 (1.69%) deep. The SHS group had 1 (3.45%) superficial infection, whereas the P group had 3 (10.00%) superficial infections and 1 (3.33%) deep infection. Infection incidence was similar for both groups (P = .37). However, in the P group, 3 (10.00%) patients developed wound dehiscence and 1 (1.69%) patient developed a fibrinous scab. Compared with SHS patients, the P patients had a greater incidence of incisional complications (1 [3.45%] vs 8 [26.67%], respectively; P = .03). The percent change in scar length was greater in the SHS group (18.04 ± 41.10%) when compared with the P group (2.00 ± 9.93%; P < .001) while the percent change in scar width was similar in the 2 groups (P = .19). The lower incidence of incisional complications and the greater reduction in scar length suggest that the inherent properties of the silver hydrogel dressing aid in postsurgical healing.
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Epstein NE. How much medicine do spine surgeons need to know to better select and care for patients? Surg Neurol Int 2012; 3:S329-49. [PMID: 23248752 PMCID: PMC3520072 DOI: 10.4103/2152-7806.103866] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 08/13/2012] [Indexed: 12/13/2022] Open
Abstract
Background: Although we routinely utilize medical consultants for preoperative clearance and postoperative patient follow-up, we as spine surgeons need to know more medicine to better select and care for our patients. Methods: This study provides additional medical knowledge to facilitate surgeons’ “cross-talk” with medical colleagues who are concerned about how multiple comorbid risk factors affect their preoperative clearance, and impact patients’ postoperative outcomes. Results: Within 6 months of an acute myocardial infarction (MI), patients undergoing urological surgery encountered a 40% mortality rate: similar rates may likely apply to patients undergoing spinal surgery. Within 6 weeks to 2 months of placing uncoated cardiac, carotid, or other stents, endothelialization is typically complete; as anti-platelet therapy may often be discontinued, spinal surgery can then be more safely performed. Coated stents, however, usually require 6 months to 1 year for endothelialization to occur; thus spinal surgery is often delayed as anti-platelet therapy must typically be continued to avoid thrombotic complications (e.g., stroke/MI). Diabetes and morbid obesity both increase the risk of postoperative infection, and poor wound healing, while the latter increases the risk of phlebitis/pulmonary embolism. Both hypercoagluation and hypocoagulation syndromes may require special preoperative testing/medications and/or transfusions of specific hematological factors. Pulmonary disease, neurological disorders, and major psychiatric pathology may also require further evaluations/therapy, and may even preclude successful surgical intervention. Conclusions: Although we as spinal surgeons utilize medical consultants for preoperative clearance and postoperative care, we need to know more medicine to better select and care for our patients.
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Affiliation(s)
- Nancy E Epstein
- Clinical Professor of Neurological Surgery, The Albert Einstein College of Medicine, Department of Neurosurgery, Bronx, New York, Chief of Neurosurgical Spine and Education, Winthrop University Hospital, Mineola, New York, President, Long Island Neurosurgical Associates, PC, 410 Lakeville Rd Suite 204, New Hyde Park, New York, USA
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