{"id":21919,"date":"2022-07-09T05:15:00","date_gmt":"2022-07-08T21:15:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=21919"},"modified":"2022-07-09T06:03:55","modified_gmt":"2022-07-08T22:03:55","slug":"lancet-infect-dis%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e9%85%92%e7%b2%be%e6%b0%af%e5%b7%b2%e5%ae%9a%e5%a4%87%e7%9a%ae%e6%88%96%e4%b8%89%e6%b0%af%e7%94%9f%e5%8c%85%e8%a2%ab%e7%bc%9d%e7%ba%bf","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=21919","title":{"rendered":"[Lancet Infect Dis\u53d1\u8868\u8bba\u6587]\uff1a\u9152\u7cbe\u6c2f\u5df2\u5b9a\u5907\u76ae\u6216\u4e09\u6c2f\u751f\u5305\u88ab\u7f1d\u7ebf\u51cf\u5c11\u624b\u672f\u90e8\u4f4d\u611f\u67d3"},"content":{"rendered":"\n

ARTICLES|ONLINE FIRST<\/a><\/p>\n\n\n\n

Alcoholic chlorhexidine skin preparation or triclosan-coated sutures to reduce surgical site infection: a systematic review and meta-analysis of high-quality randomised controlled trials<\/h1>\n\n\n\n

National Institute of Health Research Unit on Global Surgery<\/h3>\n\n\n\n

Lancet Infect Dis Published:May 26, 2022<\/h3>\n\n\n\n

DOI:https:\/\/doi.org\/10.1016\/S1473-3099(22)00133-5<\/a><\/h3>\n\n\n\n

Summary<\/h2>\n\n\n\n

Background<\/h3>\n\n\n\n

WHO and the UK's National Institute for Health and Care Excellence recommend alcoholic chlorhexidine skin preparation and triclosan-coated sutures to prevent surgical site infections (SSIs). Existing meta-analyses that include studies at high risk of bias, combined with the recent publication of large, randomised trials, justify an updated meta-analysis of high-quality randomised controlled trials (RCTs). We aimed to test the rates of SSI according to skin preparation solutions (ie, alcoholic chlorhexidine vs<\/em> aqueous povidone-iodine) and types of sutures (ie, coated vs<\/em> uncoated).<\/p>\n\n\n\n

Methods<\/h3>\n\n\n\n

In this systematic review and meta-analysis, we searched MEDLINE, Embase, Pubmed, and Cochrane Library databases, with no language restrictions, to identify high-quality RCTs testing either alcoholic chlorhexidine skin preparation (vs<\/em> aqueous povidone-iodine) or triclosan-coated sutures (vs<\/em> uncoated sutures), or both, published from database inception to Sept 1, 2021. Patients who received clean-contaminated, contaminated, or dirty surgery were included. We predefined the characteristics of a high-quality trial through an expert consensus process to develop an enhanced Cochrane risk of bias-2 tool specifically for RCTs with a primary outcome of SSI. Data were extracted from published reports. Meta-analysis was performed using a random-effects model and heterogeneity was assessed using the I<\/em>2<\/sup> statistic. This systematic review and meta-analysis was prospectively registered in PROSPERO, CRD42021267220.<\/p>\n\n\n\n

Findings<\/h3>\n\n\n\n

Of 942 studies identified, 933 were excluded. Four high-quality RCTs (n=7467 patients) were included that tested alcoholic chlorhexidine. No significant difference in SSI rates was noted between alcoholic chlorhexidine and aqueous povidone-iodine (17\u00b79% [667 of 3723 patients] vs<\/em> 19\u00b78% [740 of 3744 patients]; odds ratio 0\u00b784 [95% CI 0\u00b765\u20131\u00b706]; p=0\u00b721, I<\/em>2<\/sup>=53\u00b71%). Five high-quality RCTs were included that tested triclosan-coated sutures (n=8619 patients), with no significant difference noted between triclosan-coated and uncoated sutures (16\u00b78% [733 of 4360 patients] vs<\/em> 18\u00b74% [784 of 4259 patients]; OR 0\u00b790 [95% CI 0\u00b774\u20131\u00b709]; p=0\u00b729, I<\/em>2<\/sup>=36\u00b74%).<\/p>\n\n\n\n

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Interpretation<\/h3>\n\n\n\n

Contrary to previous meta-analyses, this study did not show a benefit from either alcoholic chlorhexidine skin preparation or triclosan-coated sutures, both of which are more expensive than other readily available alternatives. Global and national guidance should be reconsidered to remove recommendations for their routine use.<\/p>\n\n\n\n

Funding<\/h3>\n\n\n\n

National Institute for Health Research (NIHR) Global Health Research Unit.<\/p>\n","protected":false},"excerpt":{"rendered":"

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