Methods of local antimicrobic prophylaxis of surgical site infection

Abstract

Recently, to prevent of surgical site infection, new methods of local antimicrobic prophylaxis have been developed and successfully introduced, which allow to creating high concentrations of antimicrobial drugs in operated tissues and preventing the migration of bacterial flora into the wound. The review describes the main methods used for local impact on microflora and aimed at prophylaxis of surgical site infection. The latter include pre-, intra- and postoperative measures. Optimizing of preoperational methods could be achieved by improving the methods of processing of operating field. Review’s considerable attention is paid to intraoperative measures: the use of surgical gloves with antimicrobial properties, reticulated to implants with antimicrobial properties for tension-free hernioplasty, stage-by-stage surgical wound irrigation with antibacterial drugs during suturing as well as the prospects for the use of bacteriophages in abdominal surgery. To increase the biological tightness of the intestinal suture, some authors propose the use of a biodegradable antibiotic-impregnated implant. The review reflects the possibilities of using biologically active (antimicrobial) sutures, the use of which was very effective at all stages of the operation: from the application of intestinal anastomosis to the skin suture. A wide range of antimicrobial surgical sutures containing antibacterial preparations and made by threads with different biodegradation abilities make, allow us to recommend a differentiated approach to the choice of suture material depending on the stage of surgery and regenerative properties of the sutured tissues. The main measures recommended in the early postoperative period are to cover the wound with special wound coatings preventing the possible contamination and to improve irrigation-aspiration drainage techniques of postoperative wounds.

Keywords

surgical site infection / antimicrobial prophylaxis

References

[1] Smekalenkov O.A. Analysis of early infectious complications in patients after spinal surgery. Hirur­giya pozvonochnika. 2017; 14 (2): 82–87. (In Russ.) DOI: 10.14531/ss2017.2.82-87.

[2] Смекаленков О.А. Анализ ранних инфекционных осложнений у пациентов после хирургических вмешательств на позвоночнике. Хирургия позвоночника. 2017; 14 (2): 82–87. DOI: 10.14531/ss2017.2.82-87.

[3] Dobrokvashin S.V., Izmailov A.G., Volkov D.E. Prevention of wound pyo-­inflammatory complications in urgent abdominal surgery. Vestnik eksperimental'noy i klinicheskoy khirurgii. 2011; 4 (1): 143–144. (In Russ.) DOI: 10.18499/2070-478X-2011-4-1-143-144.

[4] Доброквашин С.В., Измайлов А.Г., Волков Д.Е. Профилактика раневых гнойно-воспалительных осложнений в ургентной хирургии. Вестн. эксперим. и клин. хир. 2011; 4 (1): 143–144. DOI: 10.18499/2070-478X-2011-4-1-143-144.

[5] Plechev V.V. Profilaktika gnoino-septicheskih oslozhnenii v khirurgii. (Prophylaxis of purulent-septic complications in surgery). М.: Triada-Х. 2003; 320 p. (In Russ.)

[6] Плечев В.В. Профилактика гнойно-септических осложнений в хирургии. М.: Триада-Х. 2003; 320 с.

[7] Isaev Yu.A. Mobile cecum: methods of surgical treatment. Verkhnevolzhskiy meditsinskiy zhurnal. 2018; 17 (4): 25–28. (In Russ.)

[8] Исаев Ю.А. Подвижная слепая кишка: способы оперативного лечения. Верхневолжский мед. ж. 2018; 17 (4): 25–28.

[9] Gostischev V.K. The new possibilities of postoperative complication's prophylaxis in abdominal surgery. ­Khirurgiya. Zhurnal im. N.N. Pirogova. 2011; (5): 56–60. (In Russ.)

[10] Гостищев В.К. Новые возможности профилактики послеоперационных осложнений в абдоминальной хирургии. Хирургия. Ж. им. Н.Н. Пирогова. 2011; (5): 56–60.

[11] Larichev A.B. Wound infection prevention and morphological aspects of aseptic wound healing. Vestnik ekspe­rimental'noy i klinicheskoy khirurgii. 2011; 4 (4): 728–733. (In Russ.)

[12] Ларичев А.Б. Профилактика раневой инфекции и морфологические аспекты заживления асептической раны. Вестн. эксперим. и клин. хир. 2011; 4 (4): 728–733.

[13] Scherba S.N., Savchenko U.P., Polovinkin V.V. Way of decrease of the wound it is purulent-septic complications after closing intestinal stomas. Infektsii v khirurgii. 2014; 12 (4): 5–7. (In Russ.)

[14] Щерба С.Н., Савченко Ю.П., Половинкин Ю.П. Способ снижения раневых гнойно-септических осложнений после закрытия кишечных стом. Инфекции в хир. 2014; 12 (4): 5–7.

[15] Edmiston C.E. Bacterial adherence to surgical sutures: can antibacterial-coated sutures reduce the risk of microbial contamination? J. Am. Coll. Surg. 2006; 203 (4): 481–489. DOI: 10.1016/j.jamcollsurg.2006.06.026.

[16] Mohov E.N., Sergeev A.N., Velikov P.G. Implantation antibiotics prophylaxis possibilities of the surgical-site infections in urgent abdominal surgery. Infektsii v khirurgii. 2014; 12 (2): 29–34. (In Russ.)

[17] Мохов Е.Н., Сергеев А.Н., Великов П.Г. Возможности имплантационной антибиотикопрофилактики инфекции области хирургического вмешательства в неотложной абдоминальной хирургии. Инфекции в хир. 2014; 12 (2): 29–34.

[18] Mohov E.M., Morozov A.M., Evstifeeva E.A. et al. The life quality of the patients after laparoscopic appendectomy ­using combined antimicropic prevention with use of bacteriophages in the post-operating period. Sovremennye problemy nauki i obrazovaniya. 2018; (3): 76. (In Russ.)

[19] Мохов Е.М., Морозов А.М., Евстифеева Е.А. и др. Качество жизни больных, перенёсших лапароскопическую аппендэктомию с применением в послеоперационном периоде комбинированной противомикробной профилактики с использованием бактериофагов. Соврем. пробл. науки и образования. 2018; (3): 76.

[20] Al Maqbali M.A. Preoperative antiseptic skin preparations and reducing SSI. Br. J. Nurs. 2013; 22 (21): 1227–1233. DOI: 10.12968/bjon.2013.22.21.1227.

[21] Suchomel M. Chlorhexidine-coated surgical gloves influence the bacterial flora of hands over a period of 3 hours. BMC. 2018; 7: 108. DOI: 10.1186/s13756-018-­0395-0.

[22] Gorsky V.A. The use antibiotics' enreached glue substance for the abdominal surgery. Khirurgiya. Zhurnal im. N.N. Pirogova. 2012; (4): 48–54. (In Russ.)

[23] Горский В.А. Опыт использования клеевой субстанции, насыщенной антибактериальными препаратами, в хирургии желудочно-кишечного тракта. Хирургия. Ж. им. Н.И. Пирогова. 2012; (4): 48–54.

[24] Vinnik Yu.S., Markelova N.M., Solyanikov A.S. Application of biopolymer tachocomb for the prevention of intestinal anastomotic failures: efficiency evaluation. Vrach-aspirant. 2013; (2.1): 130–134. (In Russ.)

[25] Винник Ю.С., Маркелова Н.М., Соляников А.С. Анализ эффективности применения биополимера ТахоКомб для профилактики несостоятельности кишечных анастомозов. Врач-аспирант. 2013; (2.1): 130–134.

[26] Zhukovsky V.A. Polimernye endoprotezy dlya gernioplastiki. (Polymer end oprothesis for hernioplasty.) SPb.: Eskulap. 2011; 104 p. (In Russ.)

[27] Жуковский В.А. Полимерные эндопротезы для герниопластики. СПб.: Эскулап. 2011; 104 с.

[28] Kuznetsova M.V. Inhibition of Adhesion of Staphylococcus Bacteria on Mesh Implants in Combination with Biocides (in vitro). Antibiotiki i khi­mioterapiya. 2017; (11–12): 12–20. (In Russ.)

[29] Кузнецова М.В. Ингибирование адгезии бактерий Staphylococcus на сетчатых имплантатах в комбинации с биоцидами (in vitro). Антибиотики и химиотерапия. 2017; (11–12): 12–20.

[30] Volenko A.V. Kapromed is antibacterial suture material. Me­ditsinskaya tekhnika. 1994; (2): 32–34. (In Russ.)

[31] Воленко А.В. Капромед — антибактериальный шовный материал. Мед. техника. 1994; (2): 32–34.

[32] Alexandrov K.R. Prolonged antibacterial effect of suture materials with polymer covering. Antibiotiki i khi­mioterapiya. 1991; (11): 37–40. (In Russ.)

[33] Александров К.Р. Пролонгированное антибактериальное действие шовных материалов с полимерным покрытием. Антибиотики и химиотерапия. 1991; (11): 37–40.

[34] Krasnopolsky V.I. Experience of new synthetic absorbable suture thread Kaproag us ingin obstetrics and gynecology. Meditsinskaya tekhnika. 1994; (3): 38–40. (In Russ.)

[35] Краснопольский В.И. Опыт применения новых синтетических рассасывающихся шовных нитей Капроаг в акушерстве и гинекологии. Мед. техника. 1994; (3): 38–40.

[36] Mokhov E.M., Homullo G.V., Sergeev A.N., Ale­xandrov I.V. Experimental development of new surgical suturing materials with complex biological activities. Bulletin of experimental biology and medicine. 2012; (3): 409–413. (In Russ.) DOI: 10.1007/s10517-012-1728-2.

[37] Мохов Е.М., Хомулло Г.В., Сергеев А.Н., Александров И.В. Экспериментальная разработка новых хирургических шовных материалов с комплексной биологической активностью. Бюлл. эксперим. биол. и мед. 2012; (3): 391–396. DOI: 10.1007/s10517-012-1728-2.

[38] Mohov E.M., Evtushenko N.G., Sergeev A.N. Use of biological active suture (antimicro­bal) material in surgical treatment of abdominal wall hernias. Vestnik eksperimental'noy i klinicheskoy khirurgii. 2012; (4): 648–654. (In Russ.)

[39] Мохов Е.М., Евтушенко Н.Г., Сергеев А.Н. Применение биологически активного (антимикробного) шовного материала при хирургическом лечении грыж передней брюшной стенки. Вестн. эксперим. и клин. хир. 2012; (4): 648–654.

[40] Sergeev A.N., Mokhov E.M., Sergeev N.A., Morozov A.M. Antibiotic prophylaxis for prevention of surgical site infection in emergency oncology. Arch. Euromed. 2019; 9 (3): 51–52. DOI: 10.35630/2199-885X/2019/9/3.17.

[41] Zhukovskii V.A. Current status and prospects for development and production of biologically active fibre materials for medical applications. Fibre chemistry. 2005; (5): 352–354. (In Russ.) DOI: 10.1007/s10692-006-0007-2.

[42] Жуковский В.А. Биологически активные шовные хирургические материалы. Хим. волокна. 2005; (5): ­32–35. DOI: 10.1007/s10692-006-0007-2.

[43] Zurita R., Puiggali J. Triclosan release from coated polyglycolide threads. Marcomol. Biosci. 2006; 6 (1): 58–69. DOI: 10.1002/mabi.200500147.

[44] Arikanoglu Z. The effect of different suture materials on the safety of colon anastomosis in an experimental peritonitis model. Eur. Rev. Med. Pharmacol. Sci. 2013; 17 (19): 2587–2593. PMID: 24142603.

[45] Justinger C. Surgical-site infection after abdominal wall closure with triclosan-impregnated polydioxanone sutures: results of a randomized clinical pathway facilita­ted trial (NCT00998907). Surgery. 2013; 154 (3): 589–595. DOI: 10.1016/j.surg.2013.04.011.

[46] Nakamura N. Triclosan-coated sutures reduce the incidence of wound infections and the cost after colorectal surgery: a randomized controlled trial. Surgery. 2013; 153 (4): 576–583. DOI: 10.1016/j.surg.2012.11.018.

[47] Justinger C., Slotta J.E., Schilling M.K. Incisional hernia after abdominal closure with slowly absorbable versus fast absorbable, antibacterial coated sutures. Surgery. 2012; 151 (3): 398–403. DOI: 10.1016/j.surg.2011.08.004.

[48] Hoshino S. A study of the efficacy of antibacterial sutures for surgical site infection: a retrospective controlled trial. Int. Surg. 2013; 98 (2): 129–132. DOI: 10.9738/CC179.

[49] Darvin V.V. Assessment of the effectiveness of the suture with triclosan coated in emergency surgery. Khirurgiya. Zhurnal im. N.N. Pirogova. 2017; (3): 70–75. (In Russ.) DOI: 10.17116/hirurgia2017370-75.

[50] Дарвин В.В. Оценка эффективности применения шовного материала с покрытием из триклозана в экстренной хирургии. Хирургия. Ж. им. Н.И. Пирогова. 2017; (3): 70–75. DOI: 10.17116/hirurgia2017370-75.

[51] Ming X., Rothenburger S., Nichols M. In vivo and in vitro antibacterial efficacy of PDS plus (polidioxanone with triclosan) suture. Surg. Infect. (Larchmt). 2008; 9 (4): 451–457. DOI: 10.1089/sur.2007.061.

[52] Baracs J. Surgical site infections after abdominal closure in colorectal surgery using triclosan-coated absor­bable suture (PDS Plus) vs. uncoated sutures (PDS II): a randomized multicenter study. Surg. Infect. (Larchmt). 2011; 12 (6): 483–489. DOI: 10.1089/sur.2011.001.

[53] Meijer E.J. The principles of abdominal wound closure. Acta. Chir. Belg. 2013; 113 (4): 239–244. DOI: 10.1080/00015458.2013.11680920.

[54] Ruiz-Tovar J. Association between Triclosan-­coated sutures for abdominal wall closure and incisional surgical site infection after open surgery in patients presenting with fecal peritonitis: A randomized clinical trial. Surg. Infect. (Larchmt). 2015; 16 (5): 588–594. DOI: 10.1089/sur.2014.072.

[55] McBain A.J., Rickard A.H., Gilbert P. Possible implications of biocide accumulation in the environment on the prevalence of bacterial antibiotic resistance. J. Ind. Mic­robiol. Biotechnol. 2002; 29 (6): 326–330. DOI: 10.1038/sj.jim.7000324.

[56] Obermeier A. In vitro evaluation of novel antimic­robial coatings for surgical sutures using octenidine. BMC Microbiol. 2015; 15: 186. DOI: 10.1186/s12866-015-0523-4.

[57] Chen X. Antibacterial surgical silk sutures using a high-performance slow-release carrier coating system. ACS Appl. Mater. Interfaces. 2015; 7 (40): 22 394–22 403. DOI: 10.1021/acsami.5b06239.

[58] Li Y. New bactericidal surgical suture coating. Langmuir. 2012; 28 (33): 12134–12139. DOI: 10.1021/acsami.5b06239.

[59] Pratten J. In vitro attachment of Staphylococcus epidermidis to surgical sutures with and without Ag-contai­ning bioactive glass coating. J. Biomater. Appl. 2004; 19 (1): 47–57. DOI: 10.1177/0885328204043200.

[60] Ho C.H. Long-term active antimicrobial coatings for surgical sutures based on silver nanoparticles and hyper branched polylysine. J. Biomater. Sci. Polym. Ed. 2013; 24 (13): 1589–1600. DOI: 10.1080/09205063.2013.782803.

[61] Hu W., Huang Z.M., Liu X.Y. Development of brai­ded drug-loaded nanofiber sutures. Nanotechnology. 2010; 21 (31): 315104. DOI: 10.1088/0957-4484/21/31/315104.

[62] Chumakov A.A., Fomin S.A. Two-­stages prophylaxis of purulent inflammatory complications in mini-laparotomy appendectomy. Infekcii v khirurgii. 2010; 8 (2): 36–38. (In Russ.)

[63] Чумаков А.А., Фомин С.А. Двухэтапная профилактика гнойно-воспалительных осложнений при аппендэктомии из мини-доступа. Инфекции в хир. 2010; 8 (2): 36–38.

[64] Bazilyev V.V. Prevention of wound infection in cardiac surgery: how much is topical use of antibio­tics justified? Angiologiya i sosudistaya khirurgiya. 2015; 21 (2): 107–113. (In Russ.)

[65] Базылев В.В. Профилактика раневой инфекции в кардиохирургии: насколько оправдано местное применение антибиотиков? Ангиол. и сосудист. хир. 2015; 21 (2): 107–113.

[66] Mohov E.M., Armasov A.R., Amrullaev G.A., Pazhetnev A.G. The use of the biological pro­perties of perfluorane in the local treatment of purulent wounds. Rossiyskiy meditsinskiy zhurnal. 2011; (3): 10–13. (In Russ.)

[67] Мохов Е.М., Армасов А.Р., Амруллаев Г.А., Пажетнев А.Г. Использование биологических свойств перфторана при местном лечении гнойных ран. Рос. мед. ж. 2011; (3): 10–13.

[68] Pianka F., Mihaljevic A.L. Prevention of postope­rative infections: Evidence-based principles. Chirurg. 2017; 88 (5): 401–407. DOI: 10.1007/s00104-017-0384-5.

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Sergeev A.N., Morozov A.M., Askerov E.M., Sergeev N.A., Armasov A.R., Isaev Y.A.