Triclosan-Coated Sutures Reduce the Risk of Surgical Site Infections: A Systematic Review and Meta-analysis

Abstract

OBJECTIVE To analyze available evidence on the effectiveness of triclosan-coated sutures (TCSs) in reducing the risk of surgical site infection (SSI). DESIGN Systematic review and meta-analysis. METHODS A systematic search of both randomized (RCTs) and nonrandomized (non-RCT) studies was performed on PubMed Medline, OVID, EMBASE, and SCOPUS, without restrictions in language and publication type. Random-effects models were utilized and pooled estimates were reported as the relative risk (RR) ratio with 95% confidence interval (CI). Tests for heterogeneity as well as meta-regression, subgroup, and sensitivity analyses were performed. RESULTS A total of 29 studies (22 RCTs, 7 non-RCTs) were included in the meta-analysis. The overall RR of acquiring an SSI was 0.65 (95% CI: 0.55-0.77; I2=42.4%, P=.01) in favor of TCS use. The pooled RR was particularly lower for the abdominal surgery group (RR: 0.56; 95% CI: 0.41-0.77) and was robust to sensitivity analysis. Meta-regression analysis revealed that study design, in part, may explain heterogeneity (P=.03). The pooled RR subgroup meta-analyses for randomized controlled trials (RCTs) and non-RCTs were 0.74 (95% CI: 0.61-0.89) and 0.53 (95% CI: 0.42-0.66), respectively, both of which favored the use of TCSs. CONCLUSION The random-effects meta-analysis based on RCTs suggests that TCSs reduced the risk of SSI by 26% among patients undergoing surgery. This effect was particularly evident among those who underwent abdominal surgery.

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

“…The calculated risk ratio (0.687) approached statistical significance ( P  = 0.053). The latest meta-analysis by Apisarnthanarak et al [19] evaluated a subgroup analysis in patients undergoing colorectal resection without including the most recent RCTs, [14,16] and incorporated a duplicate publication by 2 different first authors. [13,37] Their results showed a nonsignificant effect of triclosan-coated sutures in this specific cohort (relative risk 0.73, 95% CI 0.46–1.17).…”

“…Five previous meta-analyses, [19–23] investigating the impact of triclosan on SSI rate, have been published. In all of them, the estimated risk of SSI was calculated by pooling trials with patients undergoing different types of operation and levels of contamination of the surgical field.…”

“…Indeed, trials on brain, breast, appendix, colorectum, gynecological, vascular, cardiac, plastic, abdominal, and general surgery were analyzed together. Two of these meta-analyses reported subgroup analyses in patients undergoing colorectal surgery, [19,20] but they did not include the most recent large RCTs. [14,16] In this perspective, we choose to run a new meta-analysis to update the results and to select only RCTs designed for patients undergoing elective colorectal resection or RCTs including also several types of abdominal operation, but in which separate analysis on colorectal patients could be retrieved from the published data or by investigators who responded to our request of additional information.…”

Twisting electrospun nanofiber fine strips into functional sutures for sustained co-delivery of gentamicin and silver

“…6 Although triclosan-coated sutures show certain efficacy in reducing SSIs for abdominal surgeries, 7 triclosan as an antimicrobial agent has raised many questions concerning environmental pollution, food allergy, and developing bacterial resistance and cross-resistance. 8 In addition, triclosan has shown a wide range of health risks. 9 Hence, there is an imperative need to develop novel antibacterial sutures for prevention of SSIs.…”

Use of Chlorhexidine Preparations in Total Joint Arthroplasty

“…It is proposed that these could be useful in cases of triclosan resistance. Triclosan is a broad spectrum antiseptic, and triclosan coated sutures have been shown to decrease SSI, especially in abdominal surgeries 71. However, the potential benefits of these experimental applications of CHG are doubtful and have yet to be studied in TJA population.…”