Abstract
Surgical site infections (SSI) currently remain a significant medical problem due to their high incidence, severity, social consequences, and healthcare costs. An advanced approach to prevent SSI which considers surgical suture material as an implant is described in this review article. Triclosan coating or impregnation of surgical sutures may prevent microbial contamination and, therefore, reduce the risk of SSI. A body of solid evidence obtained from well-designed experimental, microbiological, and clinical studies is presented in the article.
-
1.
Kirkland K.B., Briggs J.P., Trivette S.L., et al. The impact surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999; 20:725-30.
-
2.
Bagnall N.M., Vig S., Trivedi P. Surgical-site infection. Surgery 2009; 27:426-30.
-
3.
Mangram A.J., Horan T.C., Pearson M.L., et al. Guideline for prevention of surgical site infection, 1999. HICPAC. Infect Control Hosp Epidemiol 1999; 20:250-78.
-
4.
Kirby J.P., Mazuski J.E. Prevention of surgical site infection. Surg Clin N Am 2009; 89:365-89.
-
5.
Lissovoy G., Fraeman K., Hutchins V., et al. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control 2009; 37:387-97.
-
6.
Smuth E.T., Mcllvenny G., Enstone J.E., et al. Four country healthcare associated infection prevalence survey 2006: overview of results. J Hosp Infect 2008; 69:230-48.
-
7.
Surgical site infections surveillance in England. CDR Weekly 2004; 20:14.
-
8.
Fry D.E. The economic cost of surgical site infection. Surg Infect 2002; 3 (Suppl.1):S9-21.
-
9.
Humphreys H. Preventing surgical site infections. Where now? J Hosp Infect 2009; 73:316-22.
-
10.
Coello R., Charlett A., Wilson J., et al. Adverse impact of surgical site infections in English hospitals. J Hosp Infect 2005; 60:93-103.
-
11.
Klevens R.M., Edwadrs J.R., Richards C.L., et al. Estimating health care-associated infections and death in U.S. hospitals, 2002. Public Health Rep 2007; 122:160-6.
-
12.
Страчунский Л.С., Беденков А.В., Базаров А.С. и др. Рутинная практика периоперационного назначения антибиотиков при абдоминальных операциях в России: результаты многоцентрового исследования. Clinical Microbiology and Antimicrobial Chemotherapy.2003; 5(Suppl. 1):12.
-
13.
Rosenthal R., Weber W.P., Marti W.R., et al. Surveillance of surgical site infections by surgeons: biased underreporting or useful epidemiological data? J Hosp Infect 2010; 75:178-82.
-
14.
Oliveira A.C., Lima E., Lima A. Post-discharge surgical site infection surveillance in a hospital in Brazil. Am J Surg 2007; 193:266-8.
-
15.
Daneman N., Lu H., Redelmeier D.A. Discharge after discharge: predicting surgical site infection after patients leave hospital. J Hosp Infect 2010; 75:188-94.
-
16.
Beldi G., Bisch-Knaden S., Banz V., et al. Impact of intraoperative behavior on surgical site infections. Am J Surg 2009; 198:157-62.
-
17.
Nelson R.L., Glenny A.M., Song F. Antimicrobial prophylaxis for colorectal surgery. Cochrane Database Syst Rev 2009; 1:CD001181.
-
18.
Политика применения антибиотиков в хирургии 2003. Clinical Microbiology and Antimicrobial Chemotherapy.2003; 5:30217.
-
19.
Gorbach S.L., Condon R.E., Conte J.E. Jr., Kaiser A.B., Ledger W.J., Nochols R.L. Evaluation of new antiinfective drugs for surgical prophylaxis. Clin Infect Dis 1992; 15(Suppl. 1):S313-38.
-
20.
Gorecki P., Schein M., Rucinski J.C., Wise L. Antibiotic administration in patients undergoing common surgical procedures in a community teaching hospital: the chaos continues. World J Surg 1999; 23:429-32.
-
21.
Burke J.P. Maximizing appropriate antibiotic prophylaxis for surgical patients: an update from LDS Hospital, Salt Lake City. Clin Infect Dis 2001; 33(Suppl. 2):S78-83.
-
22.
Плешков В.Г., Голуб А.В., Москалев А.П. и др. Антибактериальная профилактика и качество ее проведения в абдоминальной хирургии. Инфекции в хирургии 2007; 2:207.
-
23.
Itani K.M., Wilson S.E., Awad S.S., et al. Ertapenem versus cefotetan prophylaxis in elective colorectal surgery. N Engl J Med 2006; 355:2640-51.
-
24.
Elek S.D., Conen P.E. The virulence of Staphylococcus pyogenes for man; a study of the problems of wound infection. Br J Exp Pathol 1957; 38:573-86.
-
25.
Alexander J.W., Kaplan J.Z., Altemeier W.A. Role of suture materials in the development of wound infection. Ann Surg 1967; 165:192-9.
-
26.
Giardino R., Rocca M., Fini M., et al. Experimental evaluation, in vitro and in vivo, of the risk of infection related to the use of the most common surgical sutures. Minerva Chir 1992; 47:1799-805.
-
27.
Chu C.C., Williams D.F. Effects of physical configuration and chemical structure of suture materials on bacterial adhesion. A possible link to wound infection. Am J Surg 1984; 147:197-204.
-
28.
Edlich R.F., Panek P.H., Rodeheaver G.T., et al. Surgical sutures and infection: a biomaterial evaluation. J Biomed Mater Res 1974; 8:115-26.
-
29.
Katz S., Izhar M., Mirelman D. Bacterial adherence to surgical sutures. A possible factor in suture induced infection. Ann Surg 1981; 194:35-41.
-
30.
Chu C.C., Tsai W.C., Yao J.L., et al. Newly made antibacterial braided nylon sutures. In vitro qualitative and in vivo preliminary biocompatibility study. J Biomed Mater Res 1987; 21:1281-300.
-
31.
Tsai W.C., Chu C.C., Chiu S.S., et al. In vitro quantitative study of newly made antibacterial braided nylon sutures. Surg Gynecol Obstet 1987; 165:207-11.
-
32.
Singhal J.P., Singh J., Ray A.R., et al. Antibacterial multifilament nylon sutures. Biomater Artif Cells Immobilization Biotechnol 1991; 19:631-48.
-
33.
Rodeheaver G.T., Kurtz L.D., Bellamy W.T., et al. Biocidal braided sutures. Arch Surg 1983; 118:322-7.
-
34.
Suzuki T., Iihara H., Uno T., et al. Suture-related keratitis caused by Corynebacterium macginleyi. J Clin Microbiol 2007; 45:3833-6.
-
35.
Kathju S., Lasko L., Nistico L., et al. Cutaneous fistula from the gastric remnant resulting from a chronic suture-associated biofilm infection. Obes Surg 2010; 20:251-6.
-
36.
Hall-Stoodley L., Costerton J.W., Stoodley P. Bacterial biofilms: from environment to infection disease. Nat Rev Microbiol 2004; 2:95-108.
-
37.
Parsek M.R., Singh P.K. Bacterial biofilm: an emerging risk to disease pathogenesis. Annu Rev Microbiol 2003; 57:677-701.
-
38.
Wolcott R.D., Ehrlich G.D. Biofilms and chronic infections. JAMA 2008; 299:2682-4.
-
39.
Costerton J. W., Lewandowski Z., De Beer D., et al. Biofilms, the customized microniche. J Bacteriol 1994; 176:2137-42.
-
40.
Preston C.A., Khoury A.E., Reid G., et al. Pseudomonas aeruginosa biofilms are more susceptible to ciprofloxacin than to tobramycin. Int J Antimicrob Agents 1996; 7:251-6.
-
41.
Sandoe J.A., Wysome J., West A.P., et al. Measurement of ampicillin, vancomycin, linezolid and gentamicin activity against enterococcal biofilms. J Antimicrob Chemother 2006; 57:767-70.
-
42.
Rothenburger S., Spangler D., Bhende S., et al. In vitro antimicrobial evaluation of coated Vicryl plus antibacterial suture (coated polyglactin 910 suture with triclosan) using zone of inhibition assays. Surg Infect 2002; 3 (Suppl. 1):S79-87.
-
43.
Storch M.L., Rothenburger S.J., Jacinto G. Experimental efficacy of coated Vicril plus antibacterial sutures in guinea pigs challenged with S. aureus. Surg Infect 2004; 5:281-8.
-
44.
Ming X., Nichols M.M., Rothenburger S. In vivo antibacterial efficacy of Monocryl plus antibacterial suture (poliglecaprone 25 with triclosan). Surg Infect 2007; 8:209-14.
-
45.
Ming X., Rothenburger S., Nichols M.M. In vivo and in vitro antibacterial efficacy of PDS plus (polidioxanone with triclosan) suture. Surg Infect 2008; 9:451-7.
-
46.
Edmiston C.E., Seabrook G.R., Goheen M.P., et al. Bacterial adherence to surgical sutures: can antibacterialcoated sutures reduce the risk of microbial contamination? J Am Coll Surg 2006; 203:481-9.
-
47.
Justinger C., Moussavian M.R., Schlueter C., et al. Antibacterial [corrected] coating of abdominal closure sutures and wound infection. Surgery 2009; 145:330-4.
-
48.
Pico R.B., Jimenez L.A., Sanchez M.C., et al. Prospective study comparing the incidence of wound infection following appendectomy for acute appendicitis in children: conventional treatment versus using reabsorbable antibacterial sutures or gentamicin-impregnated collagen fleeces. Cir Pediatr 2008; 21:199-202.
-
49.
Fleck T., Moidl R., Blacky A., et al. Triclosan-coated sutures for reduction of sterna wound infections: economic considerations. Ann Thorac Surg 2007; 84:232-6.
-
50.
Rosselle C.L., Leonardo J., Li V. Antimicrobial suture wound closure for cerebrospinal fluid shunt surgery: a prospective, double-blinded, randomized controlled trial. J Neurosurg Pediatr 2008; 2:111-7.
-
51.
Stewart M.J., Parikh S., Xiao G., et al. Structural basis and mechanism of enoyl reductase inhibition by triclosan. J Mol Biol 1999; 290:859-65.
-
52.
Gilbert P., McBain A.J. Literature-based evaluation of potential risks associated with impregnation of medical devices and implants with triclosan. Surg Infect 2002; 3 (Suppl. 1):S55-63.
-
53.
Gomez Escalada M., Harwood J.L., Maillard J., et al. Triclosan inhibition of fatty acid synthesis and its effect on growth of E. coli and P. aeruginosa. J Antimicrob Chemother 2005; 55:879-82.
-
54.
Gomez Escalada M., Russell A.D., Maillard J. Triclosanbacteria interactions: single or multiple target sites? Lett Appl Microbiol 2005; 41:476-81.
-
55.
Villalain J., Mateo C.R., Aranda F.J., et al. Membranotropic effects of the antibacterial agents triclosan. Arch Boichem Biophys 2001; 390:128-36.
-
56.
Weigelt J.A., Lipsky B.A., Tabak Y., et al. Surgical site infections: causative pathogens and associated outcomes. Am J Infect Control 2010; 38:112-20.
-
57.
Suller M.T.E., Russell A.D. Triclosan and antibiotic resistance in S. aureus. J Antimicrob Chemother 2000; 46:11-8.
-
58.
Научный отчет о результатах исследования антибиотикорезистентности возбудителей нозокомиальных инфекций кожи и мягких тканей в отделениях с интенсивным использованием антибиотиков в стационарах России. Научноисследовательский институт антимикробной химиотерапии. Смоленск, 2010.
-
59.
Bhargava H.N., Leonard P.A. Triclosan: application and safety. Am J Infect Control 1996; 24:9-18.
-
60.
Aiello A.E., Marshall B., Levy S.B., et al. Relationship between triclosan and susceptibilities of bacteria isolated from hands in the community. Antimicrob Agents Chemother 2004; 48:2973-9.
-
61.
Scientific Committee on Consumer Safety. Opinion on triclosan – antimicrobial resistance. Available on ULR: http://ec.europa.eu/health/scientific_committees/consumer_safety/docs/sccs_o_023.pdf
-
62.
Smith K., Hunter I.S. Efficacy of common hospital biocides with biofilms of multi-drug resistant clinical isolates. J Med Microbiol 2008; 57:966-73.
-
63.
Barbolt T.A. 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 2002; 3 (Suppl. 1):S45-53.
-
64.
Pellinen J. Use of triclosan in surgical sutures from an environmental perspective. Summary. University of Helsinki. 2009.
-
65.
Mezcua M., Gomez M.J., Ferrer I., et al. Evidence of 2,7/2,8-dibenzodichloro-p-dioxin as a photodegradation product of triclosan in water and wastewater samples. Anal Chim Acta 2004; 524:241-7.
-
66.
Fiss E.M., Rule K.L., Vikesland P.J. Formation of chloroform and other chlorinated byproducts by chlorination of triclosan-containing antibacterial products. Environ Sci Technol 2007; 41:2387-94.
-
67.
Murray B.W., Huerta S., Dineen S., et al. Surgical site infection in colorectal surgery: a review of the nonpharmacologic tools of prevention. J Am Coll Surg 2010; article in press.
-
68.
Leaper D., McBain A.J., Kramer A., et al. Healthcare associated infection: novel strategies and antimicrobial implants to prevent surgical site infection. Ann R Coll Surg Engl 2010; 92:453-8.