Meta-analysis and trial sequential analysis of triclosan-coated sutures for the prevention of surgical-site infection

Abstract

Background: Triclosan-coated sutures (TCS) were developed to reduce the risk of surgical-site infection (SSI). Level 1A evidence of effectiveness has been presented in various recent meta-analyses, yet well designed RCTs have not been able to reproduce these favourable results. The aim of this study was to evaluate all available evidence critically with comprehensive analysis to seek a more reliable answer regarding the effectiveness of TCS in the prevention of SSI.Methods: PubMed, MEDLINE, Embase and Cochrane Library databases were searched from 1990 to November 2015 for RCTs that compared TCS with sutures that were exactly the same, but uncoated, in the prevention of SSI. Pooled relative risks (RRs) with corresponding 95 per cent confidence intervals were estimated using a random-effects model. Metaregression was used to substantiate subgroup effects, trial sequential analysis was employed to assess the risk of random error, and quality of evidence was determined using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Conclusion: GRADE assessment shows moderate-quality evidence that TCS are effective in reducing SSI. Trial sequential analysis indicates that the effect was robust, and additional data are unlikely to alter the summary effect.

Protocol changes to reduce implant‐associated infection rate after tibial plateau leveling osteotomy: 703 dogs, 811 TPLO (2006‐2014)

“…TCS materials were used explicitly for tissue closure in the postchange cohort, a decision that was based on recent CDC and World Health Organization (WHO) meta‐analyses and systematic reviews that reported a statistically significant decrease in SSI in both humans and animal models regardless of the type of procedure . TCS products have been found to inhibit bacterial adherence and the growth of several bacterial species that cause SSI, particularly methicillin‐resistant and non–methicillin‐resistant S. spp.…”

“…TCS products have been found to inhibit bacterial adherence and the growth of several bacterial species that cause SSI, particularly methicillin‐resistant and non–methicillin‐resistant S. spp. that make up the normal flora of the skin in dogs …”

The use of triclosan-coated sutures to prevent surgical site infections: a systematic review and meta-analysis of the literature

“…Since then a large number of randomised controlled trials (RCTs) have been performed with contrasting results of the effectiveness of triclosan-coated sutures in the prevention of SSIs. Subsequent meta-analyses have also produced conflicting results and hence the true effect remains unclear 6 7 27–32. The most recent and largest systematic review to date was performed by de Jonge et al and found triclosan-coated sutures significantly reduced the incidence of SSIs 32.…”

“…Subsequent meta-analyses have also produced conflicting results and hence the true effect remains unclear 6 7 27–32. The most recent and largest systematic review to date was performed by de Jonge et al and found triclosan-coated sutures significantly reduced the incidence of SSIs 32. This review searched the literature up until November 2015 and included 6462 patients from RCTs published in peer-reviewed journals as well as conference abstracts.…”

Risk factors for incisional surgical site infection after elective laparoscopic colorectal surgery

“…Surgical techniques may be able to reduce the SSI rate, and ideal approaches have long been examined, including antimicrobial suture and methods of abdominal closure . However, these previous reports have focused on open colorectal surgery, and there are few reports of risk factors for incisional SSI with laparoscopic colorectal surgery (Lap CR).…”