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Can dressings soaked with polyhexanide reduce bacterial loads in full-thickness skin grafting? A randomized controlled trial

Saleh, Karim LU ; Sonesson, Andreas LU ; Persson, Kerstin; Riesbeck, Kristian LU and Schmidtchen, Artur LU (2016) In Journal of the American Academy of Dermatology 75(6). p.4-1228
Abstract

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... (More)

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.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
bacteria, dermatologic surgery, pathogenesis, prevention, Staphylococcus aureus, surgical site infections, wound infection
in
Journal of the American Academy of Dermatology
volume
75
issue
6
pages
4 - 1228
publisher
Elsevier
external identifiers
  • scopus:84996542158
  • wos:000390032000037
ISSN
0190-9622
DOI
10.1016/j.jaad.2016.07.020
language
English
LU publication?
yes
id
0928cc0b-f9e0-4706-a9a1-105838aa1ee3
date added to LUP
2016-12-09 07:23:53
date last changed
2017-09-30 00:01:00
@article{0928cc0b-f9e0-4706-a9a1-105838aa1ee3,
  abstract     = {<p>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.</p>},
  author       = {Saleh, Karim and Sonesson, Andreas and Persson, Kerstin and Riesbeck, Kristian and Schmidtchen, Artur},
  issn         = {0190-9622},
  keyword      = {bacteria,dermatologic surgery,pathogenesis,prevention,Staphylococcus aureus,surgical site infections,wound infection},
  language     = {eng},
  month        = {12},
  number       = {6},
  pages        = {4--1228},
  publisher    = {Elsevier},
  series       = {Journal of the American Academy of Dermatology},
  title        = {Can dressings soaked with polyhexanide reduce bacterial loads in full-thickness skin grafting? A randomized controlled trial},
  url          = {http://dx.doi.org/10.1016/j.jaad.2016.07.020},
  volume       = {75},
  year         = {2016},
}