Motoi Uchino1, Toru Mizuguchi2, Hiroki Ohge3, Seiji Haji4, Junzo Shimizu5, Yasuhiko Mohri6, Chizuru Yamashita7, Yuichi Kitagawa8, Katsunori Suzuki9, Motomu Kobayashi10, Masahiro Kobayashi11, Fumie Sakamoto12, Masahiro Yoshida13, Toshihiko Mayumi14, Koichi Hirata15. 1. Department of Inflammatory Bowel Disease, Hyogo College of Medicine, 1-1, Mukogawacho, Nishinomiya, Japan. uchino2s@hyo-med.ac.jp. 2. Department of Surgery, Surgical Oncology & Science, Sapporo Medical University, Sapporo, Japan. 3. Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan. 4. Department of Surgery, Takatsuki General Hospital, Osaka, Japan. 5. Department of Surgery, Osaka Rosai Hospital, Osaka, Japan. 6. Department of Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan. 7. Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan. 8. Department of Infection Control, National Center for Geriatrics and Gerontology, Obu, Japan. 9. Division of Infection Control and Prevention, University of Occupational and Environmental Health, Fukuoka, Japan. 10. Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan. 11. Kitasato University School of Pharmacy, Tokyo, Japan. 12. Infection Control Manager, QI Center, St. Luke's International University, Tokyo, Japan. 13. Hemodialysis and Surgery, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan. 14. Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan. 15. Department of Surgery, JR Sapporo Hospital, Sapporo, Japan.
Abstract
BACKGROUND: Antimicrobial-coated sutures have recently become well known for preventing surgical site infections (SSIs). However, the evidence and recommendations from some organizations remain controversial. Therefore, we conducted a systematic review and meta-analysis to analyze the efficacy of antimicrobial-coated sutures for preventing SSIs in digestive surgery. METHODS: We performed a systematic review of literature published from 2000 to 2017 (registered on PROSPERO, No. CRD42017076780). We included studies defined as randomized controlled trials (RCTs) and observational studies (OBSs) for the prevention of SSIs and the reduction in hospital stay length associated with digestive surgery. RESULTS: In the 10 RCTs, the incidence rates of incisional SSIs were 160/1798 (8.9%) with coated sutures and 205/1690 (12.1%) with non-coated sutures. Overall, antimicrobial-coated sutures were superior for reducing the incidence of incisional SSI (risk ratio (RR) 0.67, 95% confidence intervals (CI) 0.48-0.94, p = 0.02) in RCTs for digestive surgery with the mixed wound class and surgeries limited to a clean-contaminated wound (RR 0.66, 95% CI 0.44-0.98, p = 0.04). A superior effect of antimicrobial-coated sutures was found in 9 RCTs that involved only colorectal surgeries (RR 0.69, 95% CI 0.49-0.98, p = 0.04). The mean hospital stay length was similar with coated or uncoated sutures in 5 RCTs involving colorectal surgery (mean difference (MD) - 5.00, 95% CI 16.68-6.69, p = 0.4). CONCLUSION: Antimicrobial-coated sutures are significantly more efficacious for preventing SSIs during digestive and colorectal surgery, even when restricted to clean-contaminated wounds. However, the hospital stay length was not affected.
BACKGROUND: Antimicrobial-coated sutures have recently become well known for preventing surgical site infections (SSIs). However, the evidence and recommendations from some organizations remain controversial. Therefore, we conducted a systematic review and meta-analysis to analyze the efficacy of antimicrobial-coated sutures for preventing SSIs in digestive surgery. METHODS: We performed a systematic review of literature published from 2000 to 2017 (registered on PROSPERO, No. CRD42017076780). We included studies defined as randomized controlled trials (RCTs) and observational studies (OBSs) for the prevention of SSIs and the reduction in hospital stay length associated with digestive surgery. RESULTS: In the 10 RCTs, the incidence rates of incisional SSIs were 160/1798 (8.9%) with coated sutures and 205/1690 (12.1%) with non-coated sutures. Overall, antimicrobial-coated sutures were superior for reducing the incidence of incisional SSI (risk ratio (RR) 0.67, 95% confidence intervals (CI) 0.48-0.94, p = 0.02) in RCTs for digestive surgery with the mixed wound class and surgeries limited to a clean-contaminated wound (RR 0.66, 95% CI 0.44-0.98, p = 0.04). A superior effect of antimicrobial-coated sutures was found in 9 RCTs that involved only colorectal surgeries (RR 0.69, 95% CI 0.49-0.98, p = 0.04). The mean hospital stay length was similar with coated or uncoated sutures in 5 RCTs involving colorectal surgery (mean difference (MD) - 5.00, 95% CI 16.68-6.69, p = 0.4). CONCLUSION: Antimicrobial-coated sutures are significantly more efficacious for preventing SSIs during digestive and colorectal surgery, even when restricted to clean-contaminated wounds. However, the hospital stay length was not affected.
Keywords:
Antimicrobial-coated suture; Colorectal surgery; Digestive surgery; Surgical site infection
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