Dressings for the prevention of surgical site infection

Dumville, Jo C; Gray, Trish A; Walter, C.; Sharp, Catherine; Page, Tamara; Macefield, Rhiannon; Blencowe, Natalie S; Milne, Thomas Kg; Reeves, Barnaby C; Blazeby, Jane

doi:10.1002/14651858.cd003091.pub4

Cited by 104 publications

(99 citation statements)

References 78 publications

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“…There is great need for a new approach to develop a post-surgical dressing that reduces the risk of surgical site infections. Current meta-analysis provides no evidence that current products reduce the risk of surgical site infections (50). As only primates and humans have cathelicidin antimicrobial peptide gene, our future work will be focusing on validation of these fiber formulations in a humanized transgenic mouse model or clinical trial testing by comparing systemic administration to localized delivery techniques.…”

Section: Discussionmentioning

confidence: 99%

Local Sustained Delivery of 25-Hydroxyvitamin D3 for Production of Antimicrobial Peptides

et al. 2015

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Purpose-This study seeks to develop fiber membranes for local sustained delivery of 25-hydroxyvitamin D 3 to induce the expression and secretion of LL-37 at or near the surgical site, which provides a novel therapeutic approach to minimize the risk of infections.Methods-25-hydroxyvitamin D 3 loaded poly( L -lactide) (PLA) and poly(ε-caprolactone) (PCL) fibers were produced by electrospinning. The morphology of obtained fibers was characterized using atomic force microscope (AFM) and scanning electron microscope (SEM). 25-hydroxyvitamin D 3 releasing kinetics were quantified by enzyme-linked immunosorbent assay (ELISA) kit. The expression of cathelicidin (hCAP 18) and LL-37 was analyzed by immunofluorescence staining and ELISA kit. The antibacterial activity test was conducted by incubating pseudomonas aeruginosa in a monocytes' lysis solution.Results-AFM images suggest that the surface of PCL fibers is smooth, however, the surface of PLA fibers is relatively rough, in particular, after encapsulation of 25-hydroxyvitamin D 3 . The duration of 25-hydroxyvitamin D 3 release can last more than 4 weeks for all the tested samples. Plasma treatment can promote the release rate of 25-hydroxyvitamin D 3 . Human keratinocytes and monocytes express significantly higher levels of hCAP18/LL-37 after incubation with plasma treated and 25-hydroxyvitamin D 3 loaded PCL fibers than the cells incubated with around 10 times amount of free drug. After incubation with this fiber formulation for 5 days LL-37 in the lysis solutions of U937 cells can effectively kill the bacteria.

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Section: Discussionmentioning

confidence: 99%

Local Sustained Delivery of 25-Hydroxyvitamin D3 for Production of Antimicrobial Peptides

et al. 2015

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“…The United Kingdom NICE, in a publication on surgical site infection, 17 highlighted the gap in published evidence on the use of alternate wound dressings for incisional surgical wounds 22-25 and suggested that chronic wound dressings could be used for surgical incisions to minimise the risk of SSI.…”

Section: Introductionmentioning

confidence: 99%

Incisional negative pressure wound therapy dressings (iNPWTd) in routine primary hip and knee arthroplasties

Karlakki

Hamad

Whittall

et al. 2016

Bone & Joint Research

105

110

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ObjectivesWound complications are reported in up to 10% hip and knee arthroplasties and there is a proven association between wound complications and deep prosthetic infections. In this randomised controlled trial (RCT) we explore the potential benefits of a portable, single use, incisional negative pressure wound therapy dressing (iNPWTd) on wound exudate, length of stay (LOS), wound complications, dressing changes and cost-effectiveness following total hip and knee arthroplasties.MethodsA total of 220 patients undergoing elective primary total hip and knee arthroplasties were recruited into in a non-blinded RCT. For the final analysis there were 102 patients in the study group and 107 in the control group.ResultsAn improvement was seen in the study (iNPWTd) group compared to control in all areas. Peak post-surgical wound exudate was significantly reduced (p = 0.007). Overall LOS reduction (0.9 days, 95% confidence interval (CI) -0.2 to 2.5) was not significant (p = 0.07) but there was a significant reduction in patients with extreme values of LOS in the iNPWTd group (Moses test, p = 0.003). There was a significantly reduced number of dressing changes (mean difference 1.7, 95% CI 0.8 to 2.5, p = 0.002), and a trend to a significant four-fold reduction in reported post-operative surgical wound complications (8.4% control; 2.0% iNPWTd, p = 0.06).ConclusionsBased on the results of this RCT incisional negative pressure wound therapy dressings have a beneficial role in patients undergoing primary hip and knee arthroplasty to achieve predictable length of stay, especially to eliminate excessive hospital stay, and minimise wound complications.Cite this article: S. L. Karlakki, A. K. Hamad, C. Whittall, N. M. Graham, R. D. Banerjee, J. H. Kuiper. Incisional negative pressure wound therapy dressings (iNPWTd) in routine primary hip and knee arthroplasties: A randomised controlled trial. Bone Joint Res 2016;5:328–337. DOI: 10.1302/2046-3758.58.BJR-2016-0022.R1

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“…Notwithstanding, a case for prolonged postoperative treatment in pigs could be made on the basis that contamination levels in the animal's recovery environment are likely to be greater than those found in a postoperative ward. Evidence that prolonged antimicrobial administration does not reduce SSIs and that integumentary integrity and local immune competency are probably more important than environmental isolation (Dumville and others 2011) mitigates against this.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic use of antimicrobials in surgical pig models; a literature review (2012‐2014)

et al. 2015

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There are no guidelines for antimicrobial use in experimental animals even though appropriate selection is required to reduce risk of surgical site infection (SSI) and resistance development. Pigs are used extensively as experimental surgical models for people. This review compares reported antimicrobial prescription in recently published pig surgical studies (retrieved by PubMed, Web of Knowledge and Google Scholar) with human guidelines for prophylactic antimicrobial use (National Institute of Clinical Excellence and the American Society of Health-System Pharmacists). A five-point appropriate antimicrobial use index (AAUI), based on aforementioned guidelines, was used to grade 233 studies. Use of World Health Organization-designated critically important antimicrobials (CIA) was recorded. Antimicrobial use was described in 111 of 233 (48 per cent) papers. AAUI scores of 5 (maximal compliance) and 0 (no compliance) were awarded to 34 (15 per cent) and 101 (43 per cent) articles. Where reported, prophylactic antimicrobials were mostly administered after surgery (62/95, 65 per cent) and intramuscularly (36/72, 50 per cent). CIAs were described in 21 of 111 (19 per cent) papers and SSIs in 21 of 233 (9 per cent). Reported antimicrobial prophylaxis in experimental pig surgery deviates from human clinical guidelines. This has implications for antimicrobial resistance, study quality and animal welfare. Until species-specific guidelines are formulated, experimental surgical studies involving animals would probably benefit from adherence to human guidelines.

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Dressings for the prevention of surgical site infection

Cited by 104 publications

References 78 publications

Local Sustained Delivery of 25-Hydroxyvitamin D3 for Production of Antimicrobial Peptides

Local Sustained Delivery of 25-Hydroxyvitamin D3 for Production of Antimicrobial Peptides

Incisional negative pressure wound therapy dressings (iNPWTd) in routine primary hip and knee arthroplasties

Prophylactic use of antimicrobials in surgical pig models; a literature review (2012‐2014)

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