Can dressings soaked with polyhexanide reduce bacterial loads in full-thickness skin grafting? A randomized controlled trial - 14/11/16
, Andreas Sonesson, MD, PhD a, Kerstin Persson, BS a, Kristian Riesbeck, MD, PhD b, Artur Schmidtchen, MD, PhD a, cAbstract |
Background |
Polyhexamethylene biguanide (PHMB)-based antiseptic solutions can reduce bacterial loads in different clinical settings and are believed to lower risk of infections.
Objective |
We sought to assess the efficacy of a PHMB-based solution in lowering bacterial loads of full-thickness skin grafting wounds and the risk of surgical site infections (SSIs).
Methods |
In this double-blinded clinical trial, 40 patients planned for facial full-thickness skin grafting were randomized 1:1 to receive tie-over dressings soaked with either PHMB-based solution or sterile water. Quantitative and qualitative bacterial analysis was performed on all wounds before surgery, at the end of surgery, and 7 days postoperatively. In addition, all patients were screened for nasal colonization of Staphylococcus aureus.
Results |
Analysis of wounds showed no statistically significant difference in bacterial reductions between the groups. The SSI rates were significantly higher in the intervention group (8/20) than in the control group (2/20) (P = .028). Higher postoperative bacterial loads were a common finding in SSIs (P = .011). This was more frequent when S aureus was present postoperatively (P = .034), intraoperatively (P = .03), and in patients with intranasal S aureus colonization (P = .007).
Limitations |
Assessment of SSIs is largely subjective. In addition, this was a single-center study and the total number of participants was 40.
Conclusion |
Soaking tie-over dressings with PHMB solution in full-thickness skin grafting had no effect on postoperative bacterial loads and increased the risk of SSI development. The presence of S aureus intranasally and in wounds preoperatively and postoperatively increased postoperative bacterial loads, which in turn resulted in significantly more SSIs.
Il testo completo di questo articolo è disponibile in PDF.Key words : bacteria, dermatologic surgery, pathogenesis, prevention, Staphylococcus aureus, surgical site infections, wound infection
Abbreviations used : CFU, CoNS, FTSG, PHMB, SSI
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| This article was funded by the program Innovation mot Infektion, financed by the VINNOVA–Swedish Governmental Agency for Innovation Systems, the Swedish Government Funds for Clinical Research (ALF), and the Swedish Research Council (2012-1883). |
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| Disclosure: Dr Schmidtchen received consulting support from Mölnlycke Health Care AB. Drs Saleh, Sonesson, and Riesbeck, and Ms Persson have no conflicts of interest to declare. |
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| Supplemental items available at www.jaad.org. |
Vol 75 - N° 6
P. 1221 - dicembre 2016 Ritorno al numero
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