Gastrointestinal
Triclosan sutures for surgical site infection in colorectal cancer

https://doi.org/10.1016/j.jss.2016.06.070Get rights and content

Abstract

Background

Among all procedures, surgical site infections (SSIs) in colorectal surgery continue to have the highest rate, accounting for 5%-45%. To prevent the bacterial colonization of suture material, which disables local mechanisms of wound decontamination, triclosan-coated sutures were developed. We assessed the effectiveness of triclosan-coated sutures used for skin closure on the rate of SSIs in colorectal cancer surgery.

Methods

Until August 2012, we used conventional methods for skin closure in colorectal cancer surgery at the Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine. Therefore, for the control group, we retrospectively collected surveillance data over a 1.5-y period. From September 2012, we began using triclosan-coated polydioxanone antimicrobial sutures (PDS plus) for skin and fascia closure. Hence, we collected data for the study group from September 2012 to October 2013. Differences in baseline characteristics and selection bias were adjusted using the propensity score-matching method.

Results

A total of 399 patients who underwent colorectal surgery were included in this study. There were 214 patients in the control group and 185 patients in the study group. Baseline patient characteristics were similar between the propensity score-matched groups. The incidence of SSIs was less in the study group. Multivariate logistic regression analysis showed that the site of the procedure, laparoscopic surgery, and using triclosan-coated sutures remained the independent predictors of SSIs.

Conclusions

The use of triclosan-coated sutures was advantageous for decreasing the risk of SSIs after colorectal surgery.

Introduction

Colorectal surgery continues to have the highest frequency of surgical site infections (SSIs) among all surgical procedures with a reported incidence range of 5%-45%.1, 2, 3 SSIs are associated with an increased risk of morbidity, readmission, intensive care unit stay, and mortality.4

The Centers for Disease Control and Prevention (CDC) published the guidelines for the prevention of SSIs in 1999.5 From that time, awareness regarding the need to prevent SSIs has become ubiquitous. Risk factors for SSIs in colorectal cancer surgery include obesity, diabetes, type of surgery (colon or rectum), technique of surgery (open or laparoscopic), duration of surgery, and emergency surgery.2, 6, 7 The current consensus to prevent SSI includes the use of antibiotic prophylaxis, syringe pressure irrigation, and subcutaneous drainage.8, 9, 10, 11

Closing the abdominal fascia with triclosan-coated sutures is a novel method to reduce the incidence of SSI because any foreign material increases the risk of such infections. Both in vitro and in vivo studies have shown that triclosan-coated sutures interfere with microbial lipid synthesis and subsequently attenuate bacterial growth and colonization in a broad spectrum of patients.12, 13

We previously reported that the use of triclosan-coated polydioxanone antimicrobial sutures (PDS Plus; Ethicon, Johnson & Johnson, Livingston, Scotland, UK) reduced the risk of SSIs after gastroenterologic surgery.14 However, the efficacy of PDS Plus after colorectal cancer surgery remains controversial. Therefore, the aim of this study was to evaluate the efficacy of triclosan-coated sutures in lowering the incidence of SSIs associated with abdominal closure after colorectal cancer surgery.

Section snippets

Patients and data collection

The present study was conducted in accordance with the principles of the Declaration of Helsinki, and ethical approval for the study was obtained from the Ethics Committee of Fukuoka University (approval no. 12-7-06). Until August 2012, we used conventional methods for skin closure during colorectal cancer surgery at the Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine. Therefore, for the control group, we retrospectively collected surveillance data over a 1.5-y

Results

In total, 399 patients who underwent colorectal surgery for colorectal cancer were included in this study except for nine patients who underwent emergency surgery and three patients of wound classification III-IV. There were 214 patients in the control group and 185 patients in the study group. Clinical characteristics of all patients and propensity score-matched patients are summarized in Table 1. Characteristics related to surgery of all patients and propensity score-matched patients are

Discussion

Colorectal surgery continues to have the highest incidence of SSI among all surgical procedures. Although the mechanism of SSI has not yet been fully clarified, bacterial colonization and different suture materials are reportedly risk factors for wound infection.17 Suture materials play an important role in the development of SSIs by providing a local surface for the adherence of microorganisms.18 Therefore, creating an antibacterial environment within the wound could reduce the risk of SSIs.

Conclusions

In conclusion, the results of this study suggested that the triclosan-coated sutures significantly reduced the incidence of SSIs after colorectal surgery.

Acknowledgment

Author contributions: K.Y. and S.T. equally contributed to this work; K.Y. collected and analyzed the data and drafted the manuscript; S.T. provided analytical oversight; Y.Y. designed and supervised the study; S.H. revised the manuscript for important intellectual content; S.T., S.H. offered the technical or material support; H.S., N.A., Y.Y., S.T. provided administrative support; all authors have read and approved the final version to be published.

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      The latter are generally acknowledged as being the most commonly incurred postoperative complication and represent 15–20% of all nosocomial infections arising after surgery [5,6]. It has been demonstrated that sutures loaded with antimicrobial agents (such as triclosan or silver nanoparticles) reduce infection rates and improve wound recovery [2,3,6–10]. Irrespective of design, commercial sutures are typically based on a thread-like form to provide the mechanical resilience needed to draw the wound edges together and, thereafter, the antimicrobial features are invariably delivered through passive interaction with the surrounding tissue [2].

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    The authors declare they have no financial disclosures that would be pertinent to this work.

    1

    These authors contributed equally to this work as first author.

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