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Der Chirurg

, Volume 90, Issue 1, pp 37–46 | Cite as

Triclosan-beschichtete Nahtmaterialien in der kolorektalen Chirurgie

Bewertung und Metaanalyse zu den Empfehlungen der WHO-Richtlinie
  • R. Hunger
  • A. Mantke
  • C. Herrmann
  • R. Mantke
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  • 129 Downloads

Zusammenfassung

Hintergrund

In ihren globalen Richtlinien zur Prävention postoperativer Wundinfektionen (SSI) empfiehlt die WHO den allgemeinen Einsatz Triclosan-beschichteter Nahtmaterialien (TBN) unabhängig von der Art des chirurgischen Eingriffs.

Fragestellung

Lässt sich diese Empfehlung zum Einsatz von TBN mittels Metaanalyse speziell für die kolorektale Chirurgie bestätigen?

Methoden

Mittels systematischer Literaturrecherche wurden randomisierte und nichtrandomisierte klinische Studien ermittelt, die TBN mit konventionellem Nahtmaterial hinsichtlich der Wirksamkeit zur Reduzierung der SSI-Rate bei kolorektalen Eingriffen vergleichen. Zusätzlich wurden an die einzuschließenden Studien verschiedene Qualitätskriterien gestellt: SSI-Definition gemäß CDC, A‑priori-Fallzahlkalkulation und eine maximale SSI-Rate von 20 %. Mittels eines Fixed- und Random-effects-Modells wurden die Effekte (Odds Ratios, OR) gepoolt, 95 %-Konfidenzintervalle (CIs) berechnet und Subgruppenanalysen durchgeführt.

Ergebnisse

Drei prospektiv randomisierte Studien (RCT) und 3 nichtrandomisierte Studien mit insgesamt 2957 Personen gingen in die Metaanalyse ein. Die durchschnittliche SSI-Rate betrug in den Studienarmen 6,90 % (76/1101) und in den Kontrollarmen 9,11 % (169/1856), woraus eine OR von 0,62 (95 %-CI: 0,29–1,31) resultiert. Die Subgruppenanalyse ergibt ein reduziertes SSI-Risiko für TBN bei den monozentrischen Studien (OR = 0,39; 95 %-CI: 0,25–0,60), jedoch ein erhöhtes SSI-Risiko bei den multizentrischen Studien (OR = 1,75; 95 %-CI: 1,11–2,77).

Schlussfolgerungen

Vor dem Hintergrund eines moderaten bis hohen Biasrisikos und der teilweise gegensätzlichen Befundlage der Studien kann die allgemeine Empfehlung der WHO zum Einsatz von TBN für kolorektale Eingriffe nicht bestätigt werden.

Schlüsselwörter

Postoperative Wundinfektion Systematisches Review Risikofaktoren Krankenhausinfektion Antiinfektiöse Mittel 

Triclosan-coated sutures in colorectal surgery

Assessment and meta-analysis of the recommendations of the WHO guideline

Abstract

Background

In the global guidelines for the prevention of surgical site infections (SSI), the World Health Organization (WHO) recommends the general use of triclosan-coated sutures irrespective of the type of surgical intervention.

Objective

Can this recommendation on the use of triclosan-coated sutures be confirmed by a meta-analysis specifically for colorectal surgery?

Methods

Randomized and non-randomized clinical trials comparing triclosan-coated and uncoated sutures for the efficacy in reducing the SSI rate in colorectal surgery were identified by a systematic literature review. In addition, various quality criteria were set for the studies to be included: SSI definition according to the Centers for Disease Control and Prevention (CDC), a priori sample size calculation and a maximum SSI rate of 20%. The odds ratios were pooled using a fixed and random effects model, the 95% confidence intervals (CI) were calculated and subgroup analyses were carried out.

Results

Included in the meta-analysis were 3 prospective randomized trials (RCT) and 3 non-randomized trials involving a total of 2957 subjects. The average SSI rate was 6.90% (76/1101) in the triclosan group and 9.11% (169/1856) in the control group, resulting in an odds ratio of 0.62 (95% CI: 0.29–1.31). Subgroup analysis showed a decreased risk for SSI in monocentric trials (OR = 0.39, 95% CI: 0.25–0.60) but an increased SSI risk in multicenter trials (OR = 1.75, 95% CI: 1.11–2.77).

Conclusion

Against the background of a moderate to high risk of bias and the partially contradictory findings of the studies, the general recommendation of the WHO on the use of triclosan-coated sutures for colorectal surgery could not be confirmed.

Keywords

Surgical site infection Systematic review Risk factors Cross infection Anti-Infective agents 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

R. Mantke hat in den letzten 5 Jahren Mittel zur Unterstützung der Forschung an der Medizinischen Hochschule Brandenburg und Honrare von den Firmen Catgut GmbH Markneukirchen, Signature Diagnostics AG Potsdam und Bayer AG erhalten. R. Hunger, A. Mantke und C. Herrmann geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Klinik für Allgemein- und Viszeralchirurgie, Medizinische Hochschule BrandenburgStädtisches Klinikum BrandenburgBrandenburg a.d. HavelDeutschland

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