Department of Gastrointestinal Surgery, Kosuyolu Research and Education Hospital, Istanbul, Turkey.
Department of General Surgery, Mersin University Faculty of Medicine, Mersin, Turkey.
Surg Infect (Larchmt). 2019 Dec;20(8):658-664. doi: 10.1089/sur.2019.052. Epub 2019 May 7.
Surgical site infections (SSIs) are a serious problem after abdominal surgery. This study aimed to compare closure of fascia with triclosan-coated monofilament polydioxanone (PDS) or standard PDS in decreasing the incidence of SSIs in patients who underwent abdominal surgery. In this randomized study, a total of 890 consecutive patients undergoing laparotomy for any gastrointestinal pathology were allocated to closure of the fascia with triclosan-coated PDS (treatment group; TG) or standard PDS (control group; CG). Patients were assessed every day during the hospital stay for SSIs and at the first, second, and fourth week after discharge. The surgical site was assessed in terms of superficial, deep incisional, or organ/site SSI. The main important finding was that SSIs were reduced as much as 24% by using triclosan-coated PDS. Surgical site infections occurred in 200 patients (22.4%), with 105 being early (in the first week) and 95 occurring late. Eighty five of the SSIs (19.1%) were noted in patients in the TG, whereas 115 of them (25.8%) were in the CG (p = 0.016). The infections were superficial in 126 patients, deep incisional in 48 patients, and organ/site in 26 patients. Most of patients (n = 651) had clean-contaminated sites. In subgroup analysis, SSI rates with triclosan-coated PDS were lower in clean, clean-contaminated, and contaminated incisions (0 in the TG versus 24.2% in the CG; p = 0.009; 13.6% in the TG versus 24.3% in the CG, p = 0.001; and 16.6% in the TG versus 27.8% in the CG; p < 0.0001, respectively). Closure of the fascia with triclosan-coated PDS decreased SSI rates as much as 24%. Also, SSIs were decreased significantly at clean, clean-contaminated, and contaminated sites. Therefore, triclosan-coated PDS might be recommended for fascial closure as a means of decreasing SSIs.
术后手术部位感染(SSI)是腹部手术后的一个严重问题。本研究旨在比较使用三氯生涂层单丝聚二氧杂环己酮(PDS)或标准 PDS 关闭筋膜以降低接受腹部手术的患者 SSI 发生率。在这项随机研究中,共有 890 名连续接受剖腹术治疗任何胃肠道病理的患者被分配至使用三氯生涂层 PDS 关闭筋膜(治疗组;TG)或标准 PDS(对照组;CG)。在住院期间,每天评估患者的 SSI,并在出院后第 1、2 和第 4 周进行评估。手术部位根据浅表、深部切口或器官/部位 SSI 进行评估。主要重要发现是,使用三氯生涂层 PDS 可使 SSI 降低 24%。有 200 名患者(22.4%)发生 SSI,其中 105 例为早期(第 1 周),95 例为晚期。TG 中有 85 例(19.1%)患者发生 SSI,CG 中有 115 例(25.8%)患者发生 SSI(p=0.016)。126 例患者的感染为浅表性,48 例为深部切口感染,26 例为器官/部位感染。大多数患者(n=651)的手术部位为清洁污染。在亚组分析中,使用三氯生涂层 PDS 的 SSI 发生率在清洁、清洁污染和污染切口较低(TG 中为 0 例,CG 中为 24.2%;p=0.009;TG 中为 13.6%,CG 中为 24.3%;p=0.001;TG 中为 16.6%,CG 中为 27.8%;p<0.0001)。使用三氯生涂层 PDS 关闭筋膜可使 SSI 发生率降低 24%。此外,在清洁、清洁污染和污染部位,SSI 显著降低。因此,三氯生涂层 PDS 可作为降低 SSI 的一种手段推荐用于筋膜关闭。