Systematic review and meta-analysis of sutures coated with triclosan for the prevention of surgical site infection after elective colorectal surgery according to the PRISMA statement

Abstract

Background:Several randomized clinical trials (RCTs) conducted to evaluate the effect of triclosan-coated suture on surgical site infection (SSI) yield to controversial results. The primary purpose of this systematic review and meta-analysis was to analyze the available RCTs, comparing the effect of triclosan-coated suture with uncoated suture on the incidence of SSI after elective colorectal operations. As secondary endpoint of the analysis, we considered length of hospital stay after surgery.Methods:We performed a systematic literature review through Medline, Embase, Pubmed, Scopus, Ovid, ISI Web of Science, and the Cochrane Controlled Trials Register searching for RCTs published from 1990 to 2015. To conduct these meta-analyses, we followed the guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Study inclusion criteria were as follows: parallel-group RCTs in adult populations reporting the closure of the abdominal wall after elective colorectal operation with triclosan-coated suture or noncoated suture, and reporting the outcomes considered in the meta-analysis.Results:Six trials including 2168 patients (1102 treated and 1066 controls) provided data on SSIs. The overall rate was 11.7% (129/1102) in the triclosan group and 13.4% (143/1066) in the control group (odds ratio 0.81, 95% confidence interval [CI] 0.58–1.13, P = 0.220). Heterogeneity among studies was moderate (I2 = 44.9%). No evidence of publication bias was detectable. Five RCTs (1783 patients; 914 treated and 689 controls) described hospital length of stay with no significant effect (mean difference: −0.02, 95% CI −0.11 to −0.07, P = 0.668). The I2 test for heterogeneity was 0% (P = 0.836). Moderator analyses showed no significant differences were detected in analyses comparing the suture materials (polydioxanone vs polyglactin). In open-label trials, the odds ratio for SSI risk was 0.62 (95% CI 0.20–1.93, P = 0.413), 0.77 in single-blind (95% CI 0.31–1.95, P = 0.583) and 0.85 in double-blind trials (95% CI 0.46–1.54, P = 0.582).Conclusions:Our findings failed to demonstrate a significant protective effect of triclosan-coated sutures on the occurrence of SSI after elective colorectal resections. Further large RCTs are needed before introducing this technology into clinical practice.

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

“…There have been 11 previous reviews in this topic area, the results of these reviews have been summarised in table 2 27 28 30–32 58–63. Our results support the findings of Konstantelias et al who concluded that triclosan-coated sutures were associated with a significantly lower risk of SSI when compared with standard sutures 32 61.…”

“…de Jonge et al reported a meta-analysis of 21 RCTs including 6462 patients, also concluding that triclosan-coated sutures significantly reduced the risk of SSI compared with standard sutures 32. Five out of 11 reviews included a risk of bias assessment27 31 32 59 63 and only one review assessed the quality of evidence using the GRADE criteria 59…”

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

“…Nine meta-analyses were identified from database searching [28,29,[33][34][35][36][37][38][39] (Table 2). 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].…”

Do antibacterial skin sutures reduce surgical site infections after elective open abdominal surgery? - Study protocol of a prospective, randomized controlled single center trial

“…The sample size is estimated on the basis of a two-sided chi 2 test for equality of the proportions of SSI occurrence within 30 days in the treatment and control groups (null hypothesis). Based on evidence in the literature, an infection rate of 12% is assumed for the control group and it is expected that the use of antibacterial sutures will reduce the SSI rate to 4% in the treatment group [11, 12].…”