School of Medicine, Southeast University, Nanjing, China; Research Institute of General Surgery, Jinling Hospital, Nanjing, China.
Research Institute of General Surgery, Jinling Hospital Nanjing Medical University, Nanjing, China.
J Hosp Infect. 2024 Aug;150:40-50. doi: 10.1016/j.jhin.2024.04.027. Epub 2024 May 31.
Antimicrobial-coated sutures are one of the strategies to avoid surgical site infection (SSI) caused by microbial colonization on the surface of surgical sutures.
To investigate the effectiveness of antimicrobial-coated sutures in reducing SSI and develop the latest systematic evaluation evidence for clinical SSI prevention and the use of antimicrobial-coated sutures.
The databases of MEDLINE, Embase, CINAHL, Cochrane, African Index Medicus, and WHO Global Health were searched from October 10, 1990 to March 3, 2023 with language restricted to English, Spanish, and French. Meta-analysis was used to evaluate the impact of antimicrobial-coated sutures on SSI and whether their effectiveness is influenced by the type of sutures or wounds. Subgroup analyses were conducted based on type of sutures and wounds. Finally, quality of the retrieved evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Twenty-six randomized control trials (RCTs) and nine observational studies (OBSs) met the inclusion criteria. Antimicrobial sutures significantly reduced SSI risk (RCTs: odds ratio: 0.74; 95% confidence interval: 0.63-0.87; P = 0.0002; OBSs: OR: 0.61; 95% CI: 0.48-0.76; P < 0.0001). Only subgroup analysis of Polydioxanone Suture (PDS) Plus vs PDS, Vicryl Plus vs Vicryl and mixed wounds revealed consistent results in favour of antimicrobial-coated sutures. According to GRADE, the quality of RCT evidence is moderate, while that of OBS evidence is low.
Antimicrobial-coated sutures are effective in reducing the risk of postoperative SSI among a large number of surgical patients. However, the available evidence is of moderate/low quality and many studies had conflicts of interest.
抗菌涂层缝线是避免缝线表面微生物定植引起手术部位感染（SSI）的策略之一。
调查抗菌涂层缝线在降低 SSI 方面的有效性，并为临床 SSI 预防和抗菌涂层缝线的使用提供最新的系统评价证据。
从 1990 年 10 月 10 日至 2023 年 3 月 3 日，我们检索了 MEDLINE、Embase、CINAHL、Cochrane、非洲医学索引和世界卫生组织全球卫生数据库，语言限制为英语、西班牙语和法语。我们使用荟萃分析来评估抗菌涂层缝线对 SSI 的影响，以及其有效性是否受到缝线类型或伤口的影响。根据缝线类型和伤口进行了亚组分析。最后，使用推荐评估、制定与评价分级（GRADE）评估检索到的证据质量。
符合纳入标准的有 26 项随机对照试验（RCTs）和 9 项观察性研究（OBSs）。抗菌缝线显著降低 SSI 风险（RCTs：优势比：0.74；95%置信区间：0.63-0.87；P=0.0002；OBSs：OR：0.61；95%置信区间：0.48-0.76；P<0.0001）。仅对聚二氧杂环己酮缝线（PDS）加与 PDS、薇乔 Plus 与薇乔和混合伤口的亚组分析显示抗菌涂层缝线有一致的结果。根据 GRADE，RCT 证据的质量为中等，而 OBS 证据的质量为低。
抗菌涂层缝线可有效降低大量手术患者术后 SSI 的风险。然而，现有的证据质量为中等/低，且许多研究存在利益冲突。
