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

Imran Ahmed, Adam Jonathan Boulton, Sana Rizvi, William Carlos, Edward Dickenson, N A Smith, Mike Reed, Imran Ahmed, Adam Jonathan Boulton, Sana Rizvi, William Carlos, Edward Dickenson, N A Smith, Mike Reed

Abstract

Introduction and objectives: Surgical site infections (SSIs) represent a common and serious complication of all surgical interventions. Microorganisms are able to colonise sutures that are implanted in the skin, which is a causative factor of SSIs. Triclosan-coated sutures are antibacterial sutures aimed at reducing SSIs. Our objective is to update the existing literature by systematically reviewing available evidence to assess the effectiveness of triclosan-coated sutures in the prevention of SSIs.

Methods: A systematic review of EMBASE, MEDLINE, AMED (Allied and complementary medicine database) and CENTRAL was performed to identify full text randomised controlled trials (RCTs) on 31 May 2019.

Intervention: Triclosan-coated sutures versus non-triclosan-coated sutures.

Primary outcome: Our primary outcome was the development of SSIs at 30 days postoperatively. A meta-analysis was performed using a fixed-effects model.

Results: Twenty-five RCTs were included involving 11 957 participants. Triclosan-coated sutures were used in 6008 participants and non triclosan-coated sutures were used in 5949. Triclosan-coated sutures significantly reduced the risk of SSIs at 30 days (relative risk 0.73, 95% CI 0.65 to 0.82). Further sensitivity analysis demonstrated that triclosan-coated sutures significantly reduced the risk of SSIs in both clean and contaminated surgery.

Conclusion: Triclosan-coated sutures have been shown to significantly reduced the risk of SSIs when compared with standard sutures. This is in agreement with previous work in this area. This study represented the largest review to date in this area. This moderate quality evidence recommends the use of triclosan-coated sutures in order to reduce the risk of SSIs particularly in clean and contaminated surgical procedures.

Prospero registration number: CRD42014014856.

Keywords: surgical site infection; systematic review; triclosan.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
PRISMA flow diagram of search results. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
A meta-analysis of all studies included in this review. The forest plot is comparing triclosan coated sutures vs standard sutures on risk of developing surgical site infection. On the right of the figure a summary of our risk of bias assessment can be seen.
Figure 3
Figure 3
Subgroup analysis comparing triclosan coated sutures versus standard sutures on the risk of developing superficial and deep infections.
Figure 4
Figure 4
Subgroup analysis comparing triclosan coated sutures versus standard sutures on the risk of developing surgical site infections in clean, clean contaminated, contaminated and dirty surgery.
Figure 5
Figure 5
A funnel plot to assess for the presence of publication bias.

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