The role of antimicrobial sutures in preventing surgical site infection

Abstract

INTRODUCTION Healthcare associated infections (HCAIs) are falling following widespread and enforced introduction of guidelines, particularly those that have addressed antibiotic resistant pathogens such as methicillin resistant Staphylococcus aureus or emergent pathogens such as Clostridium difficile, but no such decline has been seen in the incidence of surgical site infection (SSI), either in the UK, the EU or the US. SSI is one of the HCAIs, which are all avoidable complications of a surgical patient's pathway through both nosocomial and community care. METHODS This report is based on a meeting held at The Royal College of Surgeons of England on 21 July 2016. Using PubMed, members of the panel reviewed the current use of antiseptics and antimicrobial sutures in their specialties to prevent SSI. FINDINGS The group agreed that wider use of antiseptics in surgical practice may help in reducing reliance on antibiotics in infection prevention and control, especially in the perioperative period of open elective colorectal, hepatobiliary and cardiac operative procedures. The wider use of antiseptics includes preoperative showering, promotion of hand hygiene, (including the appropriate use of surgical gloves), preoperative skin preparation (including management of hair removal), antimicrobial sutures and the management of dehisced surgical wounds after infection. The meeting placed emphasis on the level I evidence that supports the use of antimicrobial sutures, particularly in surgical procedures after which the SSI rate is high (colorectal and hepatobiliary surgery) or when a SSI can be life threatening even when the rate of SSI is low (cardiac surgery).

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

“…At least one study found non-inferiority for chlorhexidine gluconate wash in comparison to dilute Betadine wash [84]. A special suture technique and/or materials also have been suggested to contribute to a reduction in postoperative PJIs [174,175]. On the other hand, PJI rates do not vary when staples are used instead of sutures for skin closure [176].…”

An Incision Closure Bundle for Colorectal Surgery

“…In vitro testing of triclosan‐coated sutures has demonstrated an inhibitory effect (that was sustained for seven days) on the growth of many common SSI pathogens, including MRSA and gram‐negative extended spectrum beta lactamase bacteria . Several independent meta‐analyses of randomized controlled trials report a lower SSI risk when comparing triclosan‐coated sutures with conventional (ie, noncoated) sutures . Two recent studies have suggested that the use of triclosan‐coated sutures, in the words of Leaper et al, “may result in significant savings across various surgical wound types.” (pe134 ) According to the Centre for Evidence‐Based Medicine's criteria, the large number of well‐designed randomized control trials, systematic reviews, and meta‐analyses reporting a reduction in SSIs after the use of triclosan‐coated sutures represents Level 1A clinical evidence .…”

Anti-Biofilm Activity of the Fungal Phytotoxin Sphaeropsidin A against Clinical Isolates of Antibiotic-Resistant Bacteria

“…[ 7 , 8 ]. Various studies report strategies to prevent biofilm formation on medical devices such as catheters, sutures, stents and bone cement [ 9 , 10 , 11 , 12 ]. Several researchers are involved in the design and evaluation of specific molecules with potential therapeutic use in chronic and biofilm-related infections [ 13 , 14 ].…”