Meta-analysis of Triclosan-Coated vs Non-Coated Sutures in Abdominal Surgery SSI Prevention

Overview

This systematic review and meta-analysis evaluated randomized controlled trials comparing triclosan-coated sutures to non-coated sutures for abdominal fascial closure. The analysis demonstrated that triclosan-coated sutures significantly reduce the incidence of surgical site infections (SSIs), particularly in high-income countries and with certain suture materials.

Background

Surgical site infections (SSIs) are common complications after abdominal surgery, occurring in 3–20% of patients and leading to increased morbidity, prolonged hospital stays, and higher healthcare costs. Triclosan-coated sutures were developed to reduce SSIs by exerting bactericidal effects against gram-positive and gram-negative bacteria. Despite their potential benefits, concerns exist regarding bacterial resistance, skin irritation, and environmental toxicity. Previous guidelines have not recommended triclosan-coated sutures due to insufficient data, prompting this updated meta-analysis.

Data Highlights

Key Findings

• Triclosan-coated sutures significantly reduce SSI incidence compared to non-coated sutures in abdominal fascial closure.
• The benefit is more pronounced in high-income countries with lower baseline SSI rates.
• Effectiveness varies by suture material; a significant benefit was observed with fast-absorbable braided polyglactin 910 but not with slowly absorbable monofilament polydioxanone.
• Studies with high risk of bias were excluded to ensure data reliability.
• Triclosan coating provides bactericidal activity lasting approximately one month, potentially reducing late infections.
• Potential risks of triclosan include skin irritation and environmental toxicity, but systemic exposure from sutures is low and considered safe.

Clinical Implications

Clinicians should consider using triclosan-coated sutures for abdominal fascial closure to reduce SSI risk, especially in settings with lower baseline infection rates. Selection of suture material is important, as benefits vary between types. Awareness of potential skin irritation and environmental concerns is necessary, but current evidence supports the safety of triclosan-coated sutures in clinical use.

Conclusion

Triclosan-coated sutures offer a clinically meaningful reduction in surgical site infections following abdominal surgery, particularly in high-income settings and with specific suture types. These findings support their use as part of SSI prevention strategies while balancing safety considerations.

References

1. Erasmus University Medical Center Study Protocol 2024 -- Meta-analysis of Triclosan-Coated Sutures
2. Centers for Disease Control and Prevention (CDC) -- SSI Definition and Criteria
3. World Bank Income Classification -- Country Income Levels
4. Risk of Bias 2 (RoB 2) Tool -- Bias Assessment in RCTs