Meta-analysis Reveals: The Suture You Choose Can Impact Surgical Site Infection Rates, Regardless of Wound Type

Rodrigo Arrangoiz MS, MD, FACS, FSSO

👉Meta-analysis demonstrates a 28% reduction in surgical site infection (SSI) risk with the use of triclosan-coated sutures.

👉In a meta-analysis that included 21 RCTs, 6462 patients, 95% CI: (14, 40%), P<0.001.

👉All triclosan-coated sutures in these RCTs were Ethicon Plus Antibacterial Sutures (MONOCRYL Plus Antibacterial (poliglecaprone 25) Suture, Coated VICRYL Plus Antibacterial (polyglactin 910) Suture, and PDS Plus Antibacterial (polydioxanone) Suture).

👉Four globally recognized health authorities recommend the use of triclosan-coated sutures for SSI prevention

👉CDC, WHO, NICE, and ACS/SIS guidelines on reducing the risk of surgical site infections are general to triclosan-coated sutures and are not specific to any one brand.

👉Sutures—like all implanted materials—can be a nidus for infection, because they lower the infective threshold; ie, they decrease the amount of bacteria needed to cause an SSI.

👉In fact, 67% of all SSIs are confined to the incision.

👉Plus Sutures have been shown in vitro to inhibit bacterial colonization of the suture for 7 days or more, for protection against the most common organisms associated with SSI.

👉Determining the ability of triclosan-coated sutures to help reduce the risk of SSI is the subject of 11 meta-analyses of 28 randomized controlled trials (RCTs) involving over 7,000 patients.

👉Prospectively planned meta-analyses of RCTs performed on the use of suture containing triclosan to lower SSI rates

👉Plus Sutures are available in barbed and non‑barbed designs and handle and perform just like non‑antibacterial sutures.

References:

1. de Jonge SW, Atema JJ, Solomkin JS, Boermeester MA. Meta-analysis and trial sequential analysis of triclosan-coated sutures for the prevention of surgical-site infection. Br J Surg. 2017;104(2):e118-e133. 

2. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection. JAMA Surg. 2017;152(8):784-791. doi:10.1001/jamasurg.2017.0904 

3. WHO Global Guidelines for the Prevention of Surgical Site Infection, 2016. 

4. Ban KA, Minei JP, Laronga C, et al. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg.2016;224:59-74. 

5. National Institute for Health and Care Excellence (2019) Surgical site infections: prevention and treatment (NICE Guideline 33). Available at: https://www.nice.org.uk/guidance/ng125/chapter/Recommendations#intraoperative-phase. Accessed 1 July 2019. 

6. Mangram J, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999;27(2):97-132. 

7. WHO Guidelines for Safe Surgery 2009: Safe Surgery Saves Lives. Geneva: World Health Organization; 2009. 

8. Hendley JO, Ashe KM. Effect of topical antimicrobial treatment on aerobic bacteria in the stratum corneum of human skin. Antimicrob Agents Chemother. 1991;35(4):627-631. 

9. Ward KH, Olson ME, Lam K, Costerton JW. Mechanism of persistent infection associated with peritoneal implants. J Med Microbiol.1992;36(6):406-413. 

10. Kathju S, Nistico L, Hall-Stoodley L, et al. Chronic surgical site infection due to suture-associated polymicrobial biofilm. Surg Infect (Larchmt). 2009;10(5):457-461. 

11.Rothenburger S, Spangler D, Bhende S, Burkely D. In vitro antimicrobial evaluation of Coated VICRYL* Plus Antibacterial Suture (coated polyglactin 910 with triclosan) using zone of inhibition assays. Surg Infect (Larchmt).2002;3(Suppl 1):S79-S87. 

12. Ming X, Rothenburger S, Yang D. In vitro antibacterial efficacy of MONOCRYL plus antibacterial suture (poliglecaprone 25 with triclosan). Surg Infect (Larchmt). 2007;8(2):201-207. 

13. Ming X, Rothenburger S, Nichols M. In vivo and in vitro antibacterial efficacy of PDS plus (polidioxanone with triclosan) suture. Surg Infect (Larchmt).2008;9(4):451-457. 

14. Leaper DJ, Edmiston CE Jr, Holy CE. Meta-analysis of the potential economic impact following introduction of absorbable antimicrobial sutures. Br J Surg.2017;104(2):e134-e144. 

15. Apisarnthanarak A, Singh N, Bandong AN, et al. Triclosan-Coated Sutures Reduce the Risk of Surgical Site Infections: A Systematic Review and Meta-Analysis. Infect Control Hosp Epidemiol.2015;36:169-179. 

16. 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. 

17. Daoud FC, Edmiston CE Jr, Leaper D. Meta-analysis of prevention of surgical site infections following incision closure with triclosan-coated sutures: Robustness to new evidence. Surg Infect (Larchmt). 2014;15:165-181. 

18. Daoud FC. Systematic Literature Review Update of the PROUD Trial: Potential Usefulness of a Collaborative Database. Surg Infect (Larchmt).2014;15:857-858. 

19. 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. 

20. Guo J, Pan LH, Li YX, et al. Efficacy of triclosan-coated sutures for reducing risk of surgical site infection in adults: a meta-analysis of randomized clinical trials. J Surg Res. 2016;201:105-117. 21. Sajid MS, Craciunas L, Sains P, et al. Use of antibacterial sutures for skin closure in controlling surgical site infections: a systematic review of published randomized, controlled trials. Gastroenterol Rep.2013;1:42-50. 

22. Sandini M, Mattavelli I, Nespoli L, Uggeri F, Gianotti L. 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. Medicine (Baltimore).2016;95(35):e40-57 

23. Wang ZX, Jiang CP, Cao Y, et al. Systematic review and meta-analysis of triclosan-coated sutures for the prevention of surgical-site infection. Brit J Surg. 2013;100:465-473. 

24. Wu X, Kubilay NZ, Ren J, et al. Antimicrobial-coated sutures to decrease surgical site infections: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis.2017;36(1):19-32. doi: 10.1007/s10096-016-2765-y. 

25. Ford HR, Jones P, Gaines B, Reblock K, Simpkins DL. 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 (Larchmt).2005;6(3):313-321.

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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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