Clinical Scorecard: Meta-analysis and systematic review of surgical site infections in abdominal procedures using triclosan-coated versus non-coated sutures

At a Glance

Key Highlights

• SSI occurs in 3–20% of abdominal surgery patients and increases morbidity, hospital stay, and costs.
• Triclosan-coated sutures provide sustained antimicrobial activity for up to one month, potentially reducing late infections.
• Use of triclosan-coated sutures is controversial due to concerns about bacterial resistance, skin irritation, and environmental toxicity.

Guideline-Based Recommendations

Diagnosis

• SSI defined as infection within 30 days post-surgery involving the surgical site, including superficial and deep infections per CDC criteria.

Management

• Standard SSI prevention includes disinfection, hand hygiene, aseptic protocols, prophylactic antibiotics, and minimizing operation time.
• Triclosan-coated sutures may reduce SSI incidence, particularly with fast-absorbable braided polyglactin 910 sutures.
• European and American Hernia Societies currently do not recommend triclosan-coated sutures due to insufficient data.

Monitoring & Follow-up

• Monitor for SSI signs within 30 days post-operation, including wound healing complications and infection symptoms.
• Observe for potential skin irritation with prolonged exposure to triclosan-coated sutures.

Risks

• Potential for bacterial resistance development due to triclosan exposure.
• Risk of allergic dermatitis and reversible skin irritation (GHS category 2) with prolonged contact (>4 hours).
• Environmental and human toxicity concerns with triclosan inhalation and daily use.

Patient & Prescribing Data

Adult patients undergoing abdominal fascial closure in elective or emergency surgery.

Triclosan-coated sutures show a statistically significant reduction in SSI incidence with certain suture types; systemic triclosan exposure remains low and safe.

Clinical Best Practices

• Use triclosan-coated sutures selectively, considering suture type and patient risk factors.
• Adhere to established aseptic protocols and SSI prevention measures alongside suture choice.
• Exclude studies with high risk of bias when evaluating evidence for triclosan-coated suture efficacy.
• Consider local SSI rates and healthcare setting income classification when interpreting triclosan suture benefits.

References

• Centers for Disease Control and Prevention (CDC) SSI definition
• European and American Hernia Societies guidelines on abdominal wall closure
• PROSPERO systematic review registration CRD42022332317
• Risk of Bias 2 (RoB 2) tool
• Review Manager 5 software