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Sun Jul 26 14:06:53 BST 2009

Simple answers, Ken.  NO and NO!

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of KMATTOX at aol.com
Sent: Saturday, July 25, 2009 12:55 PM
To: trauma-list at trauma.org
Subject: Urban Legend vs High science ??

Two infection type questions 

I am  aware of the research and literature concerning central lines  
impregnated with substances to impede the growth or implantation of bacteria on  
the catheter, in order to reduce central line associated sepsis and other  
infections.  

My question now applies to one  long standing question relevant  to 
orthopedic surgery and to a recent one regarding suture. 

Orthopedic surgeons are want to use custom  made antibiotic  impregnated 
beads.   I am aware of lots of literature from Europe, US  and elsewhere 
stating that they like them and that they think they decrease  infections.   I 
have even seen crude attempts at matched controls, but  not very good science 
or statistical comparisons trying to justify these in the  OR constructed 
custom made antibiotic beads used by the orthopedic  surgeons.   Does ANYONE 
have any good science supporting or against  this rather intrenched culture 
and practice.  

The other question is similar.    My plastic surgeons with  strong support 
from one of the suture companies is attempting use, and force  everyone else 
to use an absorbable suture impregnated with antibiotics, in an  attempt to 
reduce surgical wound infections.     Both the  plastic surgeons and the 
suture company have supplied me with "scientific"  papers, sponsored by, yes 
that same, suture company, showing a benefit to the  antibiotic impregnated 
suture.   The charts are nicely constructed,  and the conclusions are firmly 
stated, but from my crude calculations of the  statistics, there are not 
good matches, cross overs, or controls, and the  conclusions are those that a 
marketing agent would love to have to sell a  product.     

Any experience ?

k

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Urban Legend vs High science ??