Antiseptisch beschichtetes Nahtmaterial – gute Evidenz oder nur gutes Marketing?

Antiseptisch beschichtetes Nahtmaterial wird in den aktuellen Leitlinien der KRINKO und der WHO eingeschränkt bzw. uneingeschränkt zur Prävention von postoperativen Wundinfektionen empfohlen. Zugelassen sind nur Beschichtungen mit der umweltmedizinisch kontrovers diskutierten Substanz Triclosan. In diesem Beitrag wird die aktuell verfügbare Evidenz vorgestellt und kritisch diskutiert.

Schlüsselwörter

Surgical Site Infection (SSI) - postoperative Wundinfektionen - antimikrobiell beschichtetes Nahtmaterial - chirurgischer Faden

• Literatur

• 1 Süddeutsche.de GmbH. Implant Files: Das riskante Geschäft mit der Gesundheit. Im Internet: https://www.sueddeutsche.de/thema/Implant_Files Stand: 13.07.2019
• 2 Bundesinstitut für gesundheitlichen Verbraucherschutz und Veterinärmedizin. Änderung der BSE/TSE_Risikomaterialien-Entscheidung 97/534/EG. Im Internet: https://www.bfr.bund.de/cm/343/aenderung_der_bse_tse_risikomaterialien_entscheidung_97_534_eg.pdf Stand: 13.07.2019
• 3 B. Braun Melsungen AG. Grundlagen Nahtmaterial. Im Internet: http://www.bbraun.de/de/produkte-und-therapien/wundverschluss/aspekte-naht/grundlagen-nahtmaterial.html%23nahtmaterialursprung Stand: 13.07.2019
• 4 Barr J. Listerʼs ligatures. J Vasc Surg 2014; 60: 1383-1385
• 5 Behnke M, Aghdassi SJ, Hansen S. et al. The Prevalence of Nosocomial Infection and Antibiotic Use in German Hospitals. Dtsch Arztebl Int 2017; 114: 851-857
• 6 Robert Koch-Institut. Empfehlungen der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO). Prävention postoperativer Wundinfektionen. Bundesgesundheitsbl 2018; 61: 448-473 Im Internet: https://www.rki.de/DE/Content/Infekt/Krankenhaushygiene/Kommission/Downloads/Empf_postopWI.html Stand: 13.07.2019;
• 7 Kampf G. Triclosan. In: Antiseptic Stewardship: Biocide Resistance and Clinical Implications. Heidelberg: Springer; 2018: 211-258
• 8 Product Supply Chain Intelligence. U.S. FDA Bans Use Of Triclosan In Health Care Antiseptics. Im Internet: https://psi.ul.com/en/resources/article/u.s.-fda-bans-use-of-triclosan-in-health-care-antiseptics Stand: 13.07.2019
• 9 Federal Register – The Daily Journal of the United States Government. Safety and Effectiveness of Health Care Antiseptics; Topical Antimicrobial Drug Products for Over-the-Counter Human Use. Im Internet: https://www.federalregister.gov/documents/2017/12/20/2017-27317/safety-and-effectiveness-of-health-care-antiseptics-topical-antimicrobial-drug-products-for Stand: 13.07.2019
• 10 Kampf G. Biocidal Agents Used for Disinfection Can Enhance Antibiotic Resistance in Gram-Negative Species. Antibiotics (Basel) 2018;
• 11 Kampf G. Antibiotic Resistance Can Be Enhanced in Gram-Positive Species by Some Biocidal Agents Used for Disinfection. Antibiotics (Basel) 2019;
• 12 Yueh MF, Tukey RH. Triclosan: A Widespread Environmental Toxicant with Many Biological Effects. Annu Rev Pharmacol Toxicol 2016; 56: 251-272
• 13 Kramer A, Assadian O, Guggenbichler JP. et al. Nutzen-Risiko-Bewertung des Einsatzes von Triclosan in chirurgischem Nahtmaterial. GMS Krankenhaushygiene Interdiszip 2006; 1: Doc15
• 14 Obermeier A, Schneider J, Harrasser N. et al. Correction: Viable adhered Staphylococcus aureus highly reduced on novel antimicrobial sutures using chlorhexidine and octenidine to avoid surgical site infection (SSI). PloS One 2018; 13: e0193284
• 15 Tae BS, Park JH, Kim JK. et al. Comparison of intraoperative handling and wound healing between (NEOSORB^® plus) and coated polyglactin 910 suture (NEOSORB^®): a prospective, single-blind, randomized controlled trial. BMC Surg 2018; 18: 45
• 16 Allegranzi B, Zayed B, Bischoff P. et al. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis 2016; 16: e288-e303
• 17 Wu X, Kubilay NZ, Ren J. et al. Antimicrobial-coated sutures to decrease surgical site infections: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol 2017; 36: 19-32
• 18 Arslan NC, Atasoy G, Altintas T. et al. Effect of triclosan coated sutures on surgical site infection rate in pilonidal sinus disease: single-blinded randomized trial. Dis Colon Rectum 2014; 57: e255
• 19 Okada N, Nakamura T, Ambo Y. et al. Triclosan-coated abdominal closure sutures reduce the incidence of surgical site infections after pancreaticoduodenectomy. Surg Infect 2014; 15: 305-309
• 20 Diener MK, Knebel P, Kieser M. et al. Effectiveness of triclosan-coated PDS Plus versus uncoated PDS II sutures for prevention of surgical site infection after abdominal wall closure: the randomised controlled PROUD trial. Lancet 2014; 384: 142-152
• 21 Thimour-Bergström L, Roman-Emanuel C, Scherstén H. et al. Triclosan-coated sutures reduce surgical site infection after open vein harvesting in coronary artery bypass grafting patients: a randomized controlled trial. Eur J Cardiothorac Surg 2013; 44: 931-938
• 22 Justinger C, Slotta JE, Ningel S. et al. Surgical-site infection after abdominal wall closure with triclosan-impregnated polydioxanone sutures: results of a randomized clinical pathway facilitated trial (NCT00998907). Surgery 2013; 154: 589-595
• 23 Mattavelli I, Rebora P, Doglietto G. et al. Multi-Center Randomized Controlled Trial on the Effect of Triclosan-Coated Sutures on Surgical Site Infection after Colorectal Surgery. Surg Infect (Larchmt) 2015; 16: 226-235
• 24 Turtiainen J, Saimanen EIT, Mäkinen KT. et al. Effect of triclosan-coated sutures on the incidence of surgical wound infection after lower limb revascularization surgery: a randomized controlled trial. World J Surg 2012; 36: 2528-2534
• 25 Huszár O, Baracs J, Tóth M. et al. [Comparison of wound infection rates after colon and rectal surgeries using triclosan-coated or bare sutures – a multi-center, randomized clinical study]. Magy Seb 2012; 65: 83-91
• 26 Williams N, Sweetland H, Goyal S. et al. Randomized trial of antimicrobial-coated sutures to prevent surgical site infection after breast cancer surgery. Surg Infect 2011; 12: 469-474
• 27 Galal I, El-Hindawy K. Impact of using triclosan-antibacterial sutures on incidence of surgical site infection. Am J Surg 2011; 202: 133-138
• 28 Ban KA, Minei JP, Laronga C. et al. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg 2017; 224: 59-74
• 29 de Jonge SW, Atema JJ, Solomkin JS. et al. Meta-analysis and trial sequential analysis of triclosan-coated sutures for the prevention of surgical-site infection. Br J Surg 2017; 104: e118-e133
• 30 Konstantelias AA, Andriakopoulou CSI, Mourgela S. Triclosan-coated sutures for the prevention of surgical-site infections: a meta-analysis. Acta Chir Belg 2017; 117: 137-148
• 31 Sandini M, Mattavelli I, Nespoli L. et al. Systematic review and meta-analysis of sutures coated with triclosan for the prevention of surgical site infection after elective colorectal surgery according to the PRISMA statement. Medicine (Baltimore) 2016; 95: e4057
• 32 Elsolh B, Zhang L, Patel SV. The Effect of Antibiotic-Coated Sutures on the Incidence of Surgical Site Infections in Abdominal Closures: a Meta-Analysis. J Gastrointest Surg 2017; 21: 896-903
• 33 Henriksen NA, Deerenberg EB, Venclauskas L. et al. Triclosan-coated sutures and surgical site infection in abdominal surgery: the TRISTAN review, meta-analysis and trial sequential analysis. Hernia 2017; 21: 833-841
• 34 Hunger R, Mantke A, Herrmann C. et al. [Triclosan-coated sutures in colorectal surgery : Assessment and meta-analysis of the recommendations of the WHO guideline]. Chirurg 2019; 90: 37-46
• 35 Muysoms FE, Antoniou SA, Bury K. et al. European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia 2015; 19: 1-24
• 36 Sprowson AP, Jensen C, Parsons N. et al. The effect of triclosan-coated sutures on the rate of surgical site infection after hip and knee arthroplasty: a double-blind randomized controlled trial of 2546 patients. Bone Joint J 2018; 100-B: 296-302
• 37 Steingrimsson S, Thimour-Bergström L, Roman-Emanuel C. et al. Triclosan-coated sutures and sternal wound infections: a prospective randomized clinical trial. Eur J Clin Microbiol Infect Dis 2015; 34: 2331-2338
• 38 Renko M, Paalanne N, Tapiainen T. et al. Triclosan-containing sutures versus ordinary sutures for reducing surgical site infections in children: a double-blind, randomised controlled trial. Lancet Infect Dis 2017; 17: 50-57
• 39 Ichida K, Noda H, Kikugawa R. et al. Effect of triclosan-coated sutures on the incidence of surgical site infection after abdominal wall closure in gastroenterological surgery: a double-blind, randomized controlled trial in a single center. Surgery 2018;
• 40 Focus Online. Satte Gewinne: Pharmakonzerne geben mehr für Werbung aus als für Forschung. Im Internet: http://www.focus.de/finanzen/news/unternehmen/satte-gewinne-pharmakonzerne-geben-mehr-fuer-werbung-als-fuer-forschung-aus_id_4474123.html Stand: 13.07.2019
• 41 Market Data Forecast. Surgical Sutures Market, Opportunities and Forecasts 2014–2021. Im Internet: https://www.marketdataforecast.com/market-reports/europe-surgical-sutures-market-2770 Stand: 08.08.2019
• 42 Allied Market Research. Surgical Sutures Market Expected to Reach $5,255 Million, Globally by 2022. Im Internet: https://www.slideshare.net/alliedmarketresearch/surgical-sutures-market-expected-to-reach-5255-million-globally-by-2022 Stand. 13.07.2019
• 43 Singh A, Bartsch SM, Muder RR. et al. An economic model: value of antimicrobial-coated sutures to society, hospitals, and third-party payers in preventing abdominal surgical site infections. Infect Control Hosp Epidemiol 2014; 35: 1013-1020
• 44 Leaper DJ, Edmiston CE, Holy CE. Meta-analysis of the potential economic impact following introduction of absorbable antimicrobial sutures. Br J Surg 2017; 104: e134-e144
• 45 Arslan NC, Atasoy G, Altintas T. et al. Effect of triclosan-coated sutures on surgical site infections in pilonidal disease: prospective randomized study. Int J Colorectal Dis 2018; 33: 1445-1452
• 46 Robert Koch-Institut. Prävention von Infektionen, die von Gefäßkathetern ausgehen. Bundesgesundheitsbl 2017; 60: 171-206
• 47 Sheppard JP, Ong V, Lagman C. et al. Systemic Antimicrobial Prophylaxis and Antimicrobial-Coated External Ventricular Drain Catheters for Preventing Ventriculostomy-Related Infections: A Meta-Analysis of 5242 Cases. Neurosurgery 2018;
• 48 Schiavone PA, Corona K, Giulianelli M. et al. Antibiotic-loaded bone cement reduces risk of infections in primary total knee arthroplasty? A systematic review. Knee Surg Sports Traumatol Arthrosc 2016; 24: 3168-3174