Antibiotic Coated Sutures

Antibiotic Coated Sutures

PEP Topic 
Prevention of Infection: General
Description 

Use of antimicrobial-coated sutures for surgical closure has been examined in patients undergoing surgery for its effect in the prevention of surgical site infections in patients with cancer.

Effectiveness Not Established

Research Evidence Summaries

Chen, S.Y., Chen, T.M., Dai, N.T., Fu, J.P., Chang, S.C., Deng, S.C., & Chen, S.G. (2011). Do antibacterial-coated sutures reduce wound infection in head and neck cancer reconstruction? European Journal of Surgical Oncology, 37, 300–304.

doi: 10.1016/j.ejso.2011.01.015
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Study Purpose:

The primary aim of this study was to evaluate the effect of triclosan-coated sutures on cervical surgical wound infection rates. A secondary aim was to analyze the risk factors for wound infections in patients undergoing surgery for head and neck cancer.
 

Intervention Characteristics/Basic Study Process:

The study sample was comprised of patients who were admitted to the Tri-Service General Hospital, National Defense Medical Center, in Taipei, Taiwan, from January 2007 to December 2009. The patients were admitted for tumor ablation after a diagnosis of head and neck cancer and they received reconstructive surgery after wide excision of the tumor. The patients also had an exploration of the cervical area for radical neck lymph node disection or vascular examination for microsurgical anastomoses.

Patients were randomized into the triclosan group or a control group by a flip of a coin.

All surgical procedures were the same. All patients received IV prophylactic antibiotics (1 g cephazolin every eight hours for three days and 80 mg of gentamycin every 12 hours for three days). Dressings were changed daily for wound care and evaluation. The closed suction neck drain was removed when there was less than 10 ml per day of drainage. Infections were inspected for and defined as local erythematous change in the sutured wound with purulent discharge, cervical wound dehiscence, or neck skin necrosis. Surgical wound and intra-oral flap sutures were removed two weeks post-surgery and evaluated for delayed healing defined as intra-oral wound dehiscence and surgical complications, such as flap necrosis, intra-oral flap dehiscence, oral-cervical fistula, and neck wound infection.

Sample Characteristics:

The total sample was 241 participants.

Mean age in the triclosan group was 53.6 years (SD = 9.8); the mean age in the control group was 51.1 years (SD = 11.3).

Males made up 93.4% of the sample; females made up 6.6%.

138 patients were stage T1 or T2 (58 in the triclosan group; 80 in the control group) and 103 were stage T3 or T4 (54 in the triclosan group; 49 in the control group)

67 patients had prior head and neck reconstruction (29 in the triclosan group; 38 in the control group), 91 had preoperative radiotherapy (46 in the triclosan group; 45 in the control group), 55 had diabetes (30 in the triclosan group; 25 in the control group), 219 underwent free flap transfer (102 in the triclosan group; 117 in the control group), flap sizes in the triclosan group were an average of 81 cm2 (+ 57.9) and 72.7 cm2 (+ 56.4) in the control group, and the length of stay for participants in the triclosan group was 35.3 days (+ 14.3) and 35.9 days (+ 21) in the control group.
 

Setting:

A single-site inpatient setting in Taipei, Taiwan
 

Phase of Care and Clinical Applications:

Active treatment

Study Design:

Randomized, controlled trial

Results:

Thirty-six patients incurred infections, 17 in the triclosan group and 19 in the control group (p = 1.0). Risk factors for postoperative cervical wound infection included stages T3 and T4 (OR = 3.09, 95% CI [1.39, 6.87], p = 0.006); diabetes (OR = 2.01, 95% CI [0.88, 4.58], p = 0.098); delayed healing of intra-oral wound (OR = 5.82, 95% CI [2.66, 12.77], p < 0.001). Patients with infections had a statistically significantly longer length of stay (56.4 + 27.2 days) compared to no infection (32 + 13 days).

Conclusions:

There was no statistically significant difference in infection rates between patients who received triclosan-coated sutures and controls. Advanced tumor stage, delayed intra-oral flap healing, and oral cavity contamination by normal flora were risk factors for infection.

Nursing Implications:

Keeping the surgical site clean and clear from contamination is essential for infection prevention of surgical sites in patients with head and neck tumors. Study findings did not show a benefit with use of triclosan coated sutures in the surgical procedure.

Williams, N., Sweetland, H., Goyal, S., Ivins, N., & Leaper, D.J. (2011). Randomized trial of antimicrobial-coated sutures to prevent surgical site infection after breast cancer surgery. Surgical Infections, 12, 469–474.

doi: 10.1089/sur.2011.045
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Study Purpose:

The purpose of the study was to assess the use of antimicrobial-coated sutures compared with conventional polyglactin and poliglecaprone for skin closure after breast cancer surgery for the reduction of surgical site infections.

Intervention Characteristics/Basic Study Process:

Women diagnosed with breast cancer who were scheduled for primary elective surgery at a single center were approached for participation in the study. Following consent, they were block randomized in groups of 50 using random computer numbers. Sequential sealed envelopes were used and the type of suture to be used was revealed in the surgical suite just prior to surgery. The surgeon, patient, and assessor at follow-up were blinded. Following surgery, surgical sites were assessed at two weeks and six weeks using the Centers for Disease Control and Prevention (CDC) and ASEPSIS definitions for surgical site infections. In addition, patients completed a diary up to six weeks post-op, which included added details by the general practitioner and/or practice nurses. Other wound infection information also was gathered and included delays in radiotherapy or chemotherapy.

Sample Characteristics:

  • The sample was comprised of 150 participants, all female, and all older than age 18.
  • 75 participants were in each study arm
  • Patients were included if they had breast cancer that was not inflammatory or did not have skin ulcerations.
  • In addition to inflammatory breast cancer or skin ulcerations, patients were excluded if they received neo-adjuvant chemotherapy or radiotherapy, were having surgery for benign or reconstructive reasons, had known immune deficiency or allergy to triclosan, or were unable to give consent or appeared as if they were unlikely to comply with follow-up.

Setting:

A single site (both inpatient and outpatient) in Wales

Phase of Care and Clinical Applications:

Active treatment

Study Design:

Randomized, controlled trial; double-blinded

Measurement Instruments/Methods:

  •  CDC criteria for surgical site infections 
  •  ASEPSIS criteria for surgical site infections
  •  Southampton wound scores
  •  Demographics (age, weight, type of operation)
  •  Patient diary
  •  Document

Results:

The overall rate of surgical site infections was 18.9% at six weeks, with six patients needing an intervention or readmission for the infection. No statistically significant differences were found between types of sutures; however, use of the anti-microbial sutures did show less surgical site infections (15.2% in the anti-microbial group versus 22.9% in the control group).

Conclusions:

Anti-microbial sutures may be beneficial in the reduction of surgical site infections in adult women with breast cancer. A larger study is needed to have enough power to show statistically significant differences.

Nursing Implications:

Surgical site infections following breast cancer surgery is prevalent. Careful and frequent evaluation of the surgical site is highly important. Use of anti-microbial sutures may reduce infections.


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