Can dressings soaked with polyhexanide reduce bacterial loads in full-thickness skin grafting? A randomized controlled trial.
Karim Saleh, MD1*, Andreas Sonesson, MD, PhD1, Kerstin Persson, BS1, Kristian Riesbeck, MD, PhD2, Artur Schmidtchen, MD, PhD1,3
1Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
2Clinical Microbiology, Department of Translational Medicine, Lund University, Malmö, Sweden
3LKCMedicine, Nanyang Technological University, Singapore
Background:Polyhexamethylene biguanide (PHMB)-based antiseptic solutions can reduce bacterial loads in different clinical settings and are believed to lower risk of infections.
Objective: To assess the efficacy of a PHMB-based solution in lowering bacterial loads of full-thickness skin grafting (FTSG) wounds and the risk of SSIs.
Methods: In this double-blinded clinical trial, 40 patients planned for facial FTSG 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 S. 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 FTSG 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.
Artikeln har nu accepterats för publikation i Journal of American Academy of Dermatology (JAAD).
Handledare: Professor Artur Schmidtchen
Karim Saleh ST-läkare, SUS, Lund