Department of Inflammatory Bowel Disease, Hyogo College of Medicine, 1-1, Mukogawacho, Nishinomiya, Japan.
Department of Surgery, Surgical Oncology & Science, Sapporo Medical University, Sapporo, Japan.
J Gastrointest Surg. 2018 Oct;22(10):1832-1841. doi: 10.1007/s11605-018-3832-8. Epub 2018 Jun 20.
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.
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.
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).
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.
抗菌涂层缝线最近因其预防手术部位感染（SSI）而广为人知。然而，一些组织的证据和建议仍存在争议。因此，我们进行了一项系统评价和荟萃分析，以分析抗菌涂层缝线在消化道手术中预防 SSI 的疗效。
我们对 2000 年至 2017 年发表的文献进行了系统评价（在 PROSPERO 上注册，编号为 CRD42017076780）。我们纳入了预防 SSI 和缩短与消化道手术相关的住院时间的定义为随机对照试验（RCT）和观察性研究（OBS）的研究。
在 10 项 RCT 中，涂层缝线组的切口 SSI 发生率为 160/1798（8.9%），非涂层缝线组为 205/1690（12.1%）。总体而言，抗菌涂层缝线在混合伤口类别和仅限于清洁污染伤口的消化道手术的 RCT 中，在降低切口 SSI 发生率方面具有优势（风险比（RR）0.67，95%置信区间（CI）0.48-0.94，p=0.02）。在仅涉及结直肠手术的 9 项 RCT 中，发现抗菌涂层缝线具有更好的效果（RR 0.66，95%CI 0.44-0.98，p=0.04）。在涉及结直肠手术的 5 项 RCT 中，涂层缝线和非涂层缝线的平均住院时间相似（平均差值（MD）-5.00，95%CI 16.68-6.69，p=0.4）。
抗菌涂层缝线在消化道和结直肠手术中预防 SSI 的效果明显更优，即使仅限于清洁污染伤口。然而，住院时间没有受到影响。
