Triclosan-containing sutures

• Triclosan-Containing Sutures for the Prevention of Surgical Site Infection: A Systematic Review and Meta-Analysis
• Mucin Coatings Establish Multifunctional Properties on Commercial Sutures
• A comparative assessment of antibacterial properties of neem oil coated sutures: An in vitro study
• Comparison of the number of bacterial colonies among four types of suture threads using simple loop method following periodontal surgery in patients with periodontitis: A single-blind randomized clinical trial
• Use of monofilament sutures and triclosan coating to protect against surgical site infections in spinal surgery: a laboratory-based study
• Perioperative Interventions to Reduce Surgical Site Infections: A Review
• How to Prevent Surgical Site Infection in Vascular Surgery: A Review of the Evidence
• Temporal Change of Interleukin-6, C-Reactive Protein, and Skin Temperature after Total Knee Arthroplasty Using Triclosan-Coated Sutures

Triclosan-containing sutures are antimicrobial sutures impregnated with triclosan, a broad-spectrum antimicrobial agent effective against common pathogens like *Staphylococcus aureus* and *Staphylococcus epidermidis*. These sutures are designed to reduce the risk of surgical site infections (SSIs) by inhibiting bacterial colonization along the suture line.

- Antimicrobial Properties: Triclosan disrupts bacterial cell membranes, preventing biofilm formation.

- Common Brands: Ethicon’s Vicryl Plus, PDS Plus, and Monocryl Plus; Covidien’s V-Loc Antibacterial.

- Absorbable suture & Non-absorbable Options: Available in synthetic absorbable sutures like polyglactin 910 (Vicryl Plus) and polydioxanone (PDS Plus).

- Indications: Used in surgery, and wound closure.

- Multiple studies and meta-analyses indicate a reduction in SSIs with triclosan-coated sutures, especially in clean and clean-contaminated surgeries.

- WHO and CDC guidelines recommend the use of triclosan-coated sutures as a strategy to reduce SSIs.

- Concerns about antimicrobial resistance (AMR), although no conclusive evidence supports this. - Some debate on cost-effectiveness versus conventional sutures, though SSI reduction justifies the additional expense in many cases.

International guidelines recommend the use of triclosan-containing sutures for surgical site infection prevention. However, controversy remains about triclosan-containing suture use in clinical practice since several new randomized clinical trials (RCTs) have shown contradicting results.

Objective: To update a previous systematic review and meta-analysis of the association of triclosan-containing sutures with surgical site infections and explore the potential added value of new RCTs.

Data sources: PubMed, Embase, and Cochrane CENTRAL databases were searched from January 1, 2015, to March 14, 2023. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed.

Study selection: Published RCTs comparing triclosan-containing sutures with similar sutures without triclosan for the prevention of surgical site infections in any type of surgery were included.

Data extraction and synthesis: Two authors (H.J. and A.S.T.) independently extracted and pooled data in a random-effects (Mantel-Haenszel) model. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach, and trial sequential analysis was used to estimate whether further studies would reveal different outcomes.

Main outcomes and measures: The primary outcome was the incidence of surgical site infections, expressed as relative risk (RRs) and corresponding 95% CIs. Secondary outcomes were the incidence of surgical site infections according to depth (superficial incisional, deep incisional, and organ/space) and adverse events related to triclosan-containing sutures.

Results: The systematic review yielded 15 additional RCTs compared with a previously published review in 2017. A meta-analysis of 31 studies, including 17,968 participants (62% male) undergoing various types of surgery, was performed. The use of triclosan-containing sutures was associated with fewer surgical site infections compared with sutures without triclosan (RR, 0.75; 95% CI, 0.65-0.86). The certainty of evidence was moderate after downgrading for heterogeneity (τ2 = 0.04; I2 = 43%). In the trial sequential analysis of all trials and a sensitivity analysis excluding studies with a high risk of bias, the cumulative z curve crossed the trial sequential monitoring boundary for benefit, confirming the robustness of the summary effect estimate.

Conclusions and relevance: This updated meta-analysis found moderate-certainty evidence that wound closure with triclosan-containing sutures was associated with a lower risk of surgical site infections. The trial sequential analysis suggests that future trials that would change these findings are improbable ¹⁾.

Jalalzadeh et al.. provide a well-conducted and updated meta-analysis supporting the use of triclosan-containing sutures for SSI prevention, albeit with moderate-certainty evidence. The findings align with existing guidelines but do not fully resolve ongoing clinical controversies. Future research should focus on long-term safety, cost-effectiveness, and subgroup analyses tailored to specific surgical fields. Until then, clinicians should interpret these findings in the context of patient-specific risks and institutional infection control protocols.