Skip to main content

Advertisement

SpringerLink
Log in

Triclosan-coated sutures reduce wound infections after hepatobiliary surgery—a prospective non-randomized clinical pathway driven study

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Objectives

Wound infections after abdominal surgery are still frequent types of nosocomial infections. Suture materials might serve as a vehicle for mechanical transport of bacteria into the surgical wound. To reduce bacterial adherence to surgical sutures, triclosan-coated polyglactin 910 suture materials with antiseptic activity (Vicryl plus®) were developed. The aim of this prospective non-randomized clinical pathway driven study was to ascertain if the use of Vicryl plus® reduced the number of wound infections after transverse laparotomy.

Patients and methods

Between October 2003 and October 2007, 839 operations were performed using a transverse abdominal incision. In the first time period, a PDSII® loop suture was used for abdominal wall closure. In the second time period, we used Vicryl plus®. Risk factors were collected prospectively to compare the two groups.

Results

Using a PDSII® loop suture for abdominal wall closure in the first time period, 9.2% of the patients developed wound infections. In the second time period, using Vicryl plus®, the number of wound infections decreased to 4.3% (p < 0,005). Both groups were comparable regarding risk factors despite no other changes in protocols of patient care.

Conclusion

Antiseptic-coated loop Vicryl suture for abdominal wall closure can be superior to PDSII sutures in respect to the development of wound infections after a two-layered closure of transverse laparotomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Mangram AJ, Horan TC, Pearson M et al (1999) The Hospital Infection Control Practice Advisory Commitee. Guidelines for the prevention of surgical site infections. Am J Infect Control 27:97–132

    Article  PubMed  CAS  Google Scholar 

  2. Engemann JJ, Carmeli Y, Cosgrove SE et al (2003) Adverse and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 36:592–598

    Article  PubMed  Google Scholar 

  3. National Nosocomial Infections Surveillance System (2004) National Nosocomial Infections Surveillance (NNIS) System Report. Data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 32:470–485

    Article  Google Scholar 

  4. Edmiston CE (2001) Surgical site infection control in the critical care environment. In: Rello J, Vanes J, Kollef M (eds) Critical care infectious disease, 1st edn. Kluwer, Boston, pp 817–831

    Google Scholar 

  5. Alexander JW, Kaplan JZ, Altemeier WA (1967) Role of suture materials in the development of wound infection. Ann Surg 165:192–199

    Article  PubMed  CAS  Google Scholar 

  6. Katz S, Izhar M, Mirelman D (1981) Bacterial adherence to surgical sutures. A possible factor in suture induced infection. Ann Surg 194:235

    Article  Google Scholar 

  7. Edlich RF, Panek PH, Rodeheaver GT et al (1973) Physical and chemical configuration of sutures in the development of surgical infection. Ann Surg 177:679–687

    Article  PubMed  CAS  Google Scholar 

  8. Uff CR, Scott AD, Pockley AG et al (1995) Influence of soluble suture factors on in vitro macrophage function. Biomaterials 16:335–360

    Article  Google Scholar 

  9. Edmiston CE, Seabrook GR, Goheen MP et al (2006) Bacterial adherence to surgical sutures: can antibacterial-coated sutures reduce the risk of microbial contamination? J Am Coll Surg 203:481–498

    Article  PubMed  Google Scholar 

  10. Rothenburger S, Spangler D, Bhende S et al (2002) In vitro antimicrobial evaluation of coated VICRYL* Plus antibacterial suture (coated polyglactin 910 with triclosan) using zone of inhibition assays. Surg Infect 1:79–87

    Article  Google Scholar 

  11. Justinger C, Moussavian MR, Schlueter C et al (2009) Antibiotic coating of abdominal closure sutures and wound infection. Surgery 145(3):330–334

    Article  PubMed  Google Scholar 

  12. Seiler CM, Bruckner T, Diener MK et al (2009) Interrupted or continuous slowly absorbable sutures for closure of primary elective midline abdominal incisions: a multicenter randomized trial (INSECT: ISRCTN24023541). Ann Surg 249(4):576–582

    Article  PubMed  Google Scholar 

  13. Krukowski ZH, Cusick EL, Engeset J et al (1987) Polydioxanone or polypropylene for closure of midline abdominal incisions: a prospective comparative clinical trial. Br J Surg 74:828–830

    Article  PubMed  CAS  Google Scholar 

  14. Cameron AE, Parker CJ, Field ES et al (1987) A randomised comparison of polydioxanone (PDS) and polypropylene (Prolene) for abdominal wound closure. Ann R Coll Surg Engl 69:113–115

    PubMed  CAS  Google Scholar 

  15. Weiland DE, Bay RC, Del SS (1998) Choosing the best abdominal closure by meta-analysis. Am J Surg 176:666–670

    Article  PubMed  CAS  Google Scholar 

  16. Diener MK, Voss S, Jensen K et al (2010) Elective midline laparotomy closure: the INLINE systematic review and meta-analysis. Ann Surg 251(5):843–856

    Article  PubMed  Google Scholar 

  17. Bolli M, Schilling MK (2006) Incision and closure of the abdominal wall. Chirurg 77(5):408–413

    Article  PubMed  CAS  Google Scholar 

  18. American Society of Anesthesiologists (ASA) (1963) New classification of physical status. Anesthesiology 24:111

    Google Scholar 

  19. Zhan C, Miller MR (2003) Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA 290:1868–1874

    Article  PubMed  CAS  Google Scholar 

  20. Hodgson NC, Malthaner RA, Ostbye T (2000) The search for an ideal method of abdominal fascial closure: a meta-analysis. Ann Surg 231(3):436–442

    Article  PubMed  CAS  Google Scholar 

  21. Weber WP, Marti WR, Zwahlen M et al (2008) The timing of surgical antimicrobial prophylaxis. Ann Surg 247(6):918–926

    Article  PubMed  Google Scholar 

  22. Rodeheaver GT, Kurtz LD, Belamy WT et al (1983) Biocidal braided sutures. Arch Surg 118:322–327

    PubMed  CAS  Google Scholar 

  23. Elek SD, Conen PE (1957) The virulence of S. pyogenes for man. A study of the problems of wound infection. Br J Exp Pathol 38:573–586

    PubMed  CAS  Google Scholar 

  24. Howe CW, Marston AT (1962) A study on sources of postoperative staphylococcal infection. Surg Gynecol Obstet 115:266

    PubMed  CAS  Google Scholar 

  25. Pratten J, Nazhat SN, Blaker JJ et al (2004) In-vitro attachment of Staphylococcus epidermidis to surgical sutures with and without Ag-containing bioactive glass coating. J Biomater Appl 19:47–57

    Article  PubMed  CAS  Google Scholar 

  26. Singhal JP, Singh J, Ray AR et al (1991) Antibacterial multifilament nylon sutures. Biomater Artif Cells Immobil Biotechnol 19:631–648

    CAS  Google Scholar 

  27. Storch ML, Rothenburger SJ, Jacinto G (2004) Experimental efficacy study of coated Vicryl Plus antibacterial suture in guinea pigs challenged with Staphylococcus aureus. Surg Infect 5:281–288

    Article  Google Scholar 

  28. Gómez-Alonso A, García-Criado FJ, Parreño-Manchado FC et al (2007) Study of the efficacy of Coated VICRYL Plus antibacterial suture (coated Polyglactin 910 suture with Triclosan) in two animal models of general surgery. J Infect 54:82–88

    Article  PubMed  Google Scholar 

  29. Graeber S, Richter S, Folz J et al (2007) Clinical pathways in general surgery. Development, implementation, and evaluation. Methods Inf Med 46(5):574–579

    PubMed  CAS  Google Scholar 

  30. Schuld J, Richter S, Folz J et al (2008) Influence of IT-supported clinical pathways on patient satisfaction at a surgical department of a university hospital. Dtsch Med Wochenschr 133(23):1235–1239

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgement

The authors are grateful to Mrs. T. Serrano Contreras and Mrs. B. Kopp for their statistical assistance.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, 66421, Homburg/Saar, Germany

    Christoph Justinger, Jochen Schuld, Jens Sperling, Otto Kollmar, Sven Richter & Martin Karl Schilling

Authors
  1. Christoph Justinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jochen Schuld
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jens Sperling
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Otto Kollmar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sven Richter
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Martin Karl Schilling
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin Karl Schilling.

Additional information

This prospective non-randomized clinical pathway driven study was registered on www.clinicaltrials.gov–ID: NCT00932503.

Christoph Justinger and Jochen Schuld contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Justinger, C., Schuld, J., Sperling, J. et al. Triclosan-coated sutures reduce wound infections after hepatobiliary surgery—a prospective non-randomized clinical pathway driven study. Langenbecks Arch Surg 396, 845–850 (2011). https://doi.org/10.1007/s00423-011-0786-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-011-0786-7

Keywords

Search

Navigation