Efficiency of Antibacterial Suture Material in Cardiac Surgery: A Double-Blind Randomized Prospective Study
DOI:
https://doi.org/10.1532/HSF98.20111106Abstract
Objective: Postoperative surgical site infections (SSI) still greatly affect mortality and morbidity in cardiovascular surgery. SSI may be related to the suture material. In this prospective, randomized, controlled, and double-blinded study, the effect of antibacterial suture material on SSI in cardiac surgical patients was investigated.
Methods: We randomly allocated 510 patients into 2 groups. Antibacterial suture materials were used for wound closure in 170 patients (triclosan-coated suture group), and routine suture materials were used in 340 patients (noncoated suture group). All patients were evaluated for SSI on days 10, 20, and 30 following cardiac surgery.
Results: Preoperative risk factors and laboratory findings were comparable for the 2 groups. Sternal infection occurred in 4 (2.4%) of the patients in the triclosan-coated suture group and in 3.5% of the noncoated suture group (P > .05). Leg wound infection occurred in 5 (3.5%) of the patients in the triclosan-coated suture group and in 3.8% of the noncoated suture group (P > .05). Only diabetes mellitus was an independent predictor of SSI.
Conclusion: Both noncoated and triclosan-coated suture materials are safe. Larger studies may be needed to show the benefit and cost-effectiveness, if any, of triclosan-coated materials over noncoated materials.
References
Barbolt TA. 2002. Chemistry and safety of triclosan, and its use as an antimicrobial coating on Coated VICRYL* Plus Antibacterial Suture (coated polyglactin 910 suture with triclosan). Surg Infect (Larchmt) 3(suppl 1):S45-53.nBhatia JY, Pandey K, Rodrigues C, Mehta A, Joshi VR. 2003. Postoperative wound infection in patients undergoing coronary artery bypass graft surgery: a prospective study with evaluation of risk factors. Indian J Med Microbiol 21:246-51.nEscalada MG, Harwood HL, Maillard JY, Ochs D. 2005. Triclosan inhibition of fatty acid synthesis and its effect on growth of Escherichia coli and Pseudomonas aeruginosa. J Antimicrob Chemother 55:879-82.nFinkelstein R, Rabiano G, Mashich T, et al. 2005. Surgical site infection rates following cardiac surgery: the impact of a 6-year infection control program. Am J Infect Control 33:450-4.nFleck T, Moidl R, Balcky A, et al. 2007. Triclosan-coated suture for the reduction of sternal wound infections: economic considerations. Ann Thorac Surg 84:232-6.nFord HR, Jones P, Gaines B, Reblock K, Simpkins DL. 2005. Intraoperative handling and wound healing: controlled clinical trial comparing coated VICRYL plus antibacterial suture (coated polyglactin 910 suture with triclosan) with coated VICRYL suture (coated polyglactin 910 suture). Surg Infect (Larchmt) 6:313-21.nGårdlund B. 2007. Postoperative surgical site infections in cardiac surgery: an overview of preventive measures. APMIS 115:989-95.nHarrington G, Russo P, Spelman D, et al. 2004. Surgical-site infection rates and risk factor analysis in coronary artery bypass graft surgery. Infect Control Hosp Epidemiol 25:472-6.nJustinger C, Moussavian MR, Schlueter C, Kopp B, Kollmar O, Schilling MK. 2009. Antibacterial [corrected] coating of abdominal closure sutures and wound infection. Surgery 145:330-4.nKu CH, Ku SL, Yin JC, Lee AJ. 2005. Risk factors for sternal and leg surgical site infections after cardiac surgery in Taiwan. Am J Epidemiol 161:661-71.nLeonardo J, Rozzelle CJ. 2006. Antimicrobial suture use associated with a decreased incidence of cerebrospinal fluid shunt infections [abstract]. Neurosurgery 59:478. Abstract 872.nMalone DL, Genuit T, Tracy JK, Gannon C, Napolitano LM. 2002. Surgical site infections: reanalysis of risk factors. J Surg Res 103:89-95.nMangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. 1999. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20:250-78.nMarco F, Vallez R, Gonzalez P, Ortega L, de la Lama J, Lopez-Duran L. 2007. Study of the efficacy of coated Vicryl Plus antibacterial suture in an animal model of orthopedic surgery. Surg Infect (Larchmt) 8:359-65.nMingmalairak C, Ungbhakorn P, Paocharoen V. 2009. Efficacy of antimicrobial coating suture coated polyglactin 910 with triclosan (Vicryl Plus) compared with polyglactin 910 (Vicryl) in reduced surgical site infection of appendicitis, double blind randomized control trial, preliminary safety report. J Med Assoc Thai 92:770-5.nNichols RL. 2001. Preventing surgical site infections: a surgeon's perspective. Emerg Infect Dis 7:220-4.nOlsen M, Sundt TM, Lawton JS, et al. 2003. Risk factors for leg harvest surgical site infections after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 126:992-9.nOlsen MA, Lock-Burkley P, Hopkins D, Polish L, Sundt TM, Fraser VJ. 2002. The risk factors for deep and superficial chest surgical-site infections after coronary artery bypass graft surgery are different. J Thorac Cardiovasc Surg 124:136-45.nRogers MA, Langa KM, Kim C, et al. 2006. Contribution of infection to increased mortality in women after cardiac surgery. Arch Intern Med 166:437-43.nRozzelle CJ, Leonardo J, Li V. 2008. Antimicrobial suture wound closure for cerebrospinal fluid shunt surgery: a prospective, double-blinded, randomized controlled trial. J Neurosurg Pediatr 2:111-7.nSlater-Radosti SC, Van Alter G, Greenwood R, et al. 2001. Biochemical and genetic characterization of the action of triclosan on Staphylococcus aureus. J Antimicrob Chemother 48:1-6.nStorch M, Perry L, Davidson JM, Ward JJ. 2002. A 28-day study of the effect of Coated Vicryl* Plus Antibacterial Suture (coated polyglactin 910 with triclosan) on wound healing in guinea pig linear incisional skin wounds. Surg Infect (Larchmt) 3(suppl 1):S89-98.nSwenne CL, Borowiec J, Carlsson M, Lindholm C. 2006. Prediction of and risk factors for surgical wound infection in the saphenous vein harvesting leg in patients undergoing coronary artery bypass. Thorac Cardiovasc Surg 54:300-6.n
