Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-12-02T19:52:24.088Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  09 January 2015

Anucha Apisarnthanarak ,
Nalini Singh ,
Aila Nica Bandong  and
Gilbert Madriaga
Anucha Apisarnthanarak*
Affiliation:
Division of Infectious Diseases, Thammasat University Hospital, Pratumthani, Thailand12120
Nalini Singh
Affiliation:
Division of Infectious Diseases, Children’s National Medical Center, Department of Pediatrics, Epidemiology and Global Health, George Washington University, School of Medicine and Health Sciences, School of Public Health, Washington DC20010
Aila Nica Bandong
Affiliation:
College of Allied Medical Professions, University of the Philippines–Manila, Pedro Gil St, Ermita, Manila, Philippines1000
Gilbert Madriaga
Affiliation:
College of Public Health, University of the Philippines–Manila, Pedro Gil St, Ermita, Manila, Philippines1000
*
Address correspondence to Anucha Apisarnthanarak, MD, Division of Infectious Diseases, Thammasat University Hospital, Pratumthani, Thailand 12120 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

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.

Infect Control Hosp Epidemiol 2015;36(2): 1–11

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 2 , February 2015 , pp. 169 - 179
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. World Health Organization. Health care-associated infections: fact sheet. http://www.who.int/. Accessed May 19, 2014.Google Scholar
2. Magill, S, Edwards, J, Bamberg, W, et al. Multistate point-prevalence survey of healthcare-associated infections. New Engl J Med 2014;370:1198–1208.Google Scholar
3. Allegranzi, B, Nejad, SB, Combescure, C, et al. Burden of endemic healthcare-associated infection in developing countries: systematic review and meta-analysis. Lancet 2011;377:228–241.CrossRefGoogle ScholarPubMed
4. Rosenthal, VD, Richtmann, R, Singh, S, et al. Surgical site infections, International Nosocomial Infection Control Consortium (INICC) report, data summary of 30 countries for 2005–2010. Infect Control Hosp Epidemiol 2013;34:597–604.Google Scholar
5. Chang, WK, Srinivasa, S, Morton, R, et al. Triclosan-impregnated sutures to decrease surgical site infections: systematic review and meta-analysis of randomized trials. Ann Surg 2012;255:854–859.Google Scholar
6. Wang, ZX, Jiang, CP, Cao, Y, et al. Systematic review and meta-analysis of triclosan-coated sutures for the prevention of surgical-site infection. Br J Surg 2013;100:465–473.Google Scholar
7. Edmiston, CE, Daoud, FC, Leaper, D. Is there an evidence-based argument for embracing an antimicrobial (triclosan)-coated suture technology to reduce the risk for surgical-site infections? A meta-analysis. Surgery 2013;154:89–100.Google Scholar
8. Daoud, FC, Edmiston, CE, Leaper, D. Meta-analysis of prevention of surgical site infections following incision closure with triclosan-coated sutures: robustness to new evidence. Surg Infect 2014;15:165–181.Google Scholar
9. Higgins, JPT, Green, S. Cochrane handbook for systematic reviews of interventions. http://www.cochrane-handbook.org. Published 2011. Accessed May 19, 2014.Google Scholar
10. Shrier, I, Steele, RJ, Platt, RW, et al. Should meta-analyses of interventions include observational studies in addition to randomized controlled trials? A critical examination of underlying principles. Am J Epidemiol 2007;166:1203–1209.Google Scholar
11. Wells, GA, Shea, B, O’Connell, D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. http://www.ohri.ca/. Accessed May 19, 2014.Google Scholar
12. Garner, JS. CDC guideline for prevention of surgical wound infections, 1985. Supersedes guideline for prevention of surgical wound infections published in 1982. (Originally published in November 1985). Revised Infect Control 1986;7:193–200.Google Scholar
13. Baracs, J, Huszar, O, Sajjadi, SG, et al. Surgical site infections after abdominal closeure in colorectal surgery using triclosan-coated absorbable suture (PDS Plus) vs uncoated sutures (PDS II): a randomized multicenter study. Surg Infect 2011;12:483–489.Google Scholar
14. Chen, SY, Chen, TM, Dai, NT, et al. Do antibacterial-coated sutures reduce wound infection in head and neck cancer reconstruction? Eur J Surg Oncol 2011;37:300–304.Google Scholar
15. DeFazio, A, Datta, MS, Nezhat, C. Does the use of Vicryl Plus antibacterial suture decrease the incidence of umbilical infection when compared to Vicryl suture? [abstract 90]. J Minim Invasive Gynecol 2005;12:5.Google Scholar
16. Deliaert, AE, Van den Kerckhove, E, Tuinder, S, et al. The effect of triclosan-coated sutures in wound healing. A double-blind randomised prospective pilot study. J Plast Reconstr Aesthet Surg 2008;62:771–773.Google Scholar
17. Diener, MK, Knebel, P, Kieser, M, et al. Effectiveness of triclosan-coated PDS Plus versus uncoated PDS II sutures for prevention of surgical site infection after abdominal wall closure: the randomized controlled PROUD trial. Lancet 2014;384:142–152.Google Scholar
18. Ford, HR, Jones, P, Gaines, B, et al. Intraoperative handling and wound healing: controlled clinical trial comparing coated VICRYL® Plus antibacterial suture (coated Polyglactin 910 suture with triclosan) with coated VICRYL® suture (coated Polyglactin 910 suture). Surg Infect 2005;6:3.Google Scholar
19. Galal, I, El-Hindawy, K. Impact of using triclosan-antibacterial sutures on incidence of surgical site infection. Am J Surg 2011;202:133–138.Google Scholar
20. Hoshino, S, Yoshida, Y, Tanimura, S, et al. A study of the efficacy of antibacterial sutures for surgical site infection: a retrospective controlled trial. Int Surg 2013;98:129–132.Google Scholar
21. Huszar, O, Baracs, J, Toth, M, et al. A comparison of wound infection rates after colon and rectal surgeries using triclosan-coated suture—a multi-center, randomized clinical study. Magyar Sebészet 2012;65:83–91.Google Scholar
22. Isik, I, Selimen, D, Senay, S, et al. Efficiency of antibacterial suture material in cardiac surgery: a double-blind randomized prospective study. Heart Surg Forum 2012;15:E40–E45.Google Scholar
23. Justinger, C, Moussavian, MR, Schlueter, C, et al. Antibiotic coating of abdominal closure sutures and wound infection. Surgery 2009;145:330–334.Google Scholar
24. Justinger, C, Schuld, J, Sperling, J. Triclosan-coated sutures reduce wound infections after hepatobiliary surgery—a prospective non-randomized clinical pathway driven study. Langenbecks Arch Surg 2011;396:845–850.Google Scholar
25. Justinger, C, Slotta, J, Ningel, S, et al. Surgical-site infection after abdominal wall closure with triclosan-impregnated polydioxanone sutures: results of a randomized clinical pathway facilitated trial. J Surg 2013;154:589–595.Google Scholar
26. Khachatryan, N, Dibirov, M, Omelyanovsky, V, et al. Prevention of postoperative infections in abdominal surgery using reabsorbable suture with antibacterial activity (Vicryl Plus) versus reabsorbable sutures[abstract28]. In: 24th European Congress on Surgical Infections (Leon, Spain) Surg Infect 2011;12:2.Google Scholar
27. Laas, E, Poilroux, C, Bézu, C, et al. Antibacterial-coated suture in reducing surgical site infection in breast surgery: a prospective study. Int J Breast Cancer 2012 doi: 10.1155/2012/819578.Google Scholar
28. Mattavelli, I, Nespoli, L, Alfieri, S, et al. Triclosan-coated suture to reduce surgical site infection after colorectal surgery [abstract31]. Surg Infect 2011;12:A14–A15.Google Scholar
29. Mingmalairak, C, Ungbhakorn, P, Paocharoen, V. Efficacy of antimicrobial coating suture coated Polyglactin 910 with Tricosan (Vicryl Plus) compared with Polyglactin 910 (Vicryl) in reduced surgical site infection of appendicitis, double-blind randomized control trial, preliminary safety report. J Med Assoc Thai 2009;92:6.Google Scholar
30. Nakamura, T, Kashimura, N, Noji, T, et al. Triclosan-coated sutures reduce the incidence of wound infections and the costs after colorectal surgery: a randomized controlled trial. J Surg 2013;53:576–583.Google Scholar
31. Okada, N, Nakamura, T, Ambo, Y, et al. Triclosan-coated abdominal closure sutures reduce the incidence of surgical site infections after pancreaticoduodenectomy. Surg Infect 2014;15:305–309.CrossRefGoogle ScholarPubMed
32. Rasic, Z, Schwarz, D, Adam, VN, et al. Efficacy of antimicrobial triclosan-coated polyglactin 910 (Vicryl Plus) suture for closure of the abdominal wall after colorectal surgery. Coll Antropol 2011;2:439–443.Google Scholar
33. Rozzelle, CJ, Leonardo, J, Li, AV. Antimicrobial suture wound closure for cerebrospinal fluid shunt surgery: a prospective, double-blinded, randomized controlled trial. J Neurosurg Pediatr 2008;2:111–117.Google Scholar
34. Seim, B, Tønnessena, T, Woldbaeka, P. Triclosan-coated sutures do not reduce leg wound infections after coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2012;15:411–415.Google Scholar
35. Singh, H, Emmert, MY, Sakaguchi, H, et al. Antibacterial suture reduces surgical site infections in coronary artery bypass grafting [abstract PP16]. In: 5th International Meeting of The Onassis Cardiac Surgery Center. Heart Surgery Forum (Athens). 2010;13:S85.Google Scholar
36. Thimour-Bergström, L, Roman-Emanue, C, Scherstén, H, et al. Triclosan-coated sutures reduce surgical site infection after open vein harvesting in coronary artery bypass grafting patients: a randomized controlled trial. Eur J Cardiothorac Surg 2013;44:931–938.Google Scholar
37. Turtiainen, J, Saimanen, ET, Makinen, K, et al. Effect of triclosan-coated sutures on the incidence of surgical wound infection after lower limb revascularization surgery: a randomized controlled trial. World J Surg 2012;36:2528–2534.Google Scholar
38. Ueno, M, Saito, W, Yamagata, M, et al. Triclosan-coated sutures reduce wound infections after spinal surgery: a retrospective, nonrandomized, clinical study. Spine [in press].Google Scholar
39. Williams, N, Sweetland, H, Goyal, S, et al. Randomized trial of antimicrobial-coated sutures to prevent surgical site infection after breast cancer surgery. Surg Infect 2011;12:469–474.Google Scholar
40. Zhang, Z, Zhang, H, Fang, X, et al. Cosmetic outcome and surgical site infection rates of antibacterial absorbable (Polyglactin 910) suture compared to Chinese silk suture in breast cancer surgery: a randomized pilot research. Chin Med J 2011;124:719–724.Google Scholar
41. Zhuang, C, Cai, G, Wang, Y. Comparison of two absorbable sutures in abdominal wall incision. J Clin Rehab Tissue Eng Res 2009;13:4045–4048.Google Scholar
42. Yokoe, DS, Anderson, DJ, Berenholtz, SM, et al. Introduction to “A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates.” Infect Control Hosp Epidemiol 2014;35:455–459.CrossRefGoogle Scholar
43. Anderson, DJ, Podgorny, KP, Berríos-Torres, SI. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:605–627.Google Scholar