Association between Triclosan-Coated Sutures for Abdominal Wall Closure and Incisional Surgical Site Infection after Open Surgery in Patients Presenting with Fecal Peritonitis: A Randomized Clinical Trial

Abstract

The use of triclosan-coated sutures in fecal peritonitis surgery reduces the incidence of incisional SSI.

Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines

“…Four of these included only colorectal procedures, whereas Diener et al [35] included all types of elective procedures through a midline laparotomy. Justinger et al [36] included both elective and emergency laparotomies, whereas Ruiz-Tovar et al [37] included only cases with fecal peritonitis and Mingmalairak et al [38] studied patients undergoing open appendectomies. When evaluating PDS sutures separately, there was no effect of triclosan coating on the rate of SSI (OR 0.85; CI 0.61-1.17).…”

The Clinical and Economic Value of Triclosan-Coated Surgical Sutures in Abdominal Surgery

“…After the critical appraisal of all publications, Henriksen et al was selected as the latest meta-analysis that best matched the inclusion and exclusion criteria [28]. This meta-analysis included eight randomized trials that investigated the role of TCS in preventing SSIs in adult patients undergoing gastrointestinal surgery [20][21][22][23][24][25][26][27]. In the pooled analysis, the authors found a significant reduction of SSIs in the experimental group (SSI rate 10.1% for TCS versus 13.5% for CS; OR: 0.67; 95% CI: 0.46-0.98; p = 0.04).…”

“…The characteristics of the studies included in the Henriksen et al meta-analysis are summarized in Table 3. The heterogeneity among the RCTs was high: four trials [20,23,26,27] encompassed only elective colorectal surgery, one [21] comprised all types of elective procedures through a midline laparotomy, another [22] included both elective and emergency laparotomies, another [24] evaluated only emergency surgery for fecal peritonitis, and the final study [25] analyzed only patients undergoing open appendectomy. The study sample size varied from 100 to 1185 patients; the role of laparoscopy was not clearly reported in the majority of studies.…”

“…The most common antibacterial agent that is used to coat sutures is triclosan, which offers broad-spectrum bactericidal action against Gram-positive and Gram-negative bacteria [14]. In both in vitro and in vivo studies, microorganisms that are responsible for SSIs were prevented from binding to and colonizing triclosan-coated sutures (TCS), with the action lasting roughly 30 days from the implantation of these sutures [15,16].Guidelines, including those issued by the US Center for Disease Control (CDC), WHO, the American College of Surgeons (ACS), and National Institute for Health and clinical Excellence (NICE), recommend the use of TCS for the prevention of SSIs [16][17][18][19].Several randomized clinical trials have investigated the efficacy of TCS in reducing SSI following abdominal surgery; some have established a positive effect of TCS, whereas others have failed to demonstrate statistically significant differences versus conventional absorbable sutures (CS) [20][21][22][23][24][25][26][27]. Recent meta-analyses reported a significant effect, or at least a positive trend, in favor of TCS over CS in reducing SSI rates following abdominal surgery [28,29].…”

“…Several randomized clinical trials have investigated the efficacy of TCS in reducing SSI following abdominal surgery; some have established a positive effect of TCS, whereas others have failed to demonstrate statistically significant differences versus conventional absorbable sutures (CS) [20][21][22][23][24][25][26][27]. Recent meta-analyses reported a significant effect, or at least a positive trend, in favor of TCS over CS in reducing SSI rates following abdominal surgery [28,29].…”