Chlorhexidine - coated vs non-coated Suture to prevent surgical site infections following laparoscopic abdominal...

Surgical site infection (SSI) is the second most frequently reported health-care related infection and is accompanied by significant morbidity and considerable costs. Since cutaneous, bacterial contamination plays an important role, antimicrobial coated threads may - amongst other measures - reduce or prevent SSI.

This international, multicentric, parallel, double-blinded prospective, randomized, controlled trial (RCT) evaluated a new Chlorhexidine-(CHD) coated braided suture material ([Poly(glycolid-co-l-lactid 90/10)]; PGL-CHD) in comparison to the identical non-coated suture material (PGL) to close trocar incisions in patients undergoing laparoscopic appendectomy or cholecystectomy for the prevention of SSI. Primary endpoint was the incidence of SSI one month after surgery. Secondary outcomes were postoperative pain, suture material handling, length of hospital stay, quality of life, aesthetic result and the postoperative complication rate including hernias. Randomization was performed intra-operatively using sealed opaque envelopes. The patient was blinded to the type of suture material & the observer who was involved in the postsurgical wound assessment. Patients were followed up until 12 months after surgery.

In total, 337 patients were enrolled, 323 randomized, whereby 161 cases received PGL-CHD & 162 PGL suture material. One month follow-up examination was completed in 297 individuals. SSI rate in the whole population was 5%. In total 10 SSI occurred in the uncoated suture group (10/162; 95%CI: 6.17% [3.26-11.12%]) and 6 in the coated group (6/158; 95% CI: 3.79% [1.57-8.22%]), p = 0.44. Surgical handling of both suture materials was rated as very good and the pain level decreased from preoperative to postoperative and patients were pain-free 30 days after surgery. The long-term follow-up showed an excellent cosmetic assessment of the wound by the patient as well as by the observer, and an improvement of quality of life over time with no difference in the various suture and indication groups. The overall 1 year hernia rate was low with 0.9%, mean length of hospital stay was reported with 2.90 ± 2.29 days and only a few patients (6/323) were admitted to ICU.

The SSI rate in the CHD-coated suture group compared to the uncoated group was lower, but failed to reach significance.