Antimicrobial Sutures Prevent Surgical Site Infections and Lower Costs

By Will Boggs MD

February 06, 2017

NEW YORK (Reuters Health) - Sutures coated with antimicrobial agents like triclosan prevent surgical site infections (SSI) and significantly lower healthcare costs, according to two new meta-analyses.

Triclosan kills a range of bacteria associated with SSI and inhibits colonization of those bacteria on the suture surface.

In one study, Dr. M. A. Boermeester from Academic Medical Center in Amsterdam and colleagues analyzed results from 21 randomized controlled trials, with 3,208 patients assigned to triclosan-coated sutures (TCS) and 3,254 assigned to standard sutures.

The researchers assessed the overall risk of bias as serious and noted that six studies had a potential conflict of interest, four had no potential conflict of interest, and 11 had an unclear potential conflict of interest.

TCS reduced the overall risk of SSI by 28% (p<0.001), although the effect could not be substantiated in a strict selection of high-quality studies, the team reports in the British Journal of Surgery, online January 17.

In subgroup analyses, the benefits of TCS could be substantiated only for polyglactin 910 sutures and for clean surgical procedures, but even these could not be substantiated in analyses restricted to high-quality studies.

"GRADE assessment shows moderate quality of evidence that TCS are effective in reducing SSI," the authors conclude. Trial sequential analysis "shows that the effect was robust, and additional data are not likely to alter the summary effect, although the true effect may be somewhat smaller than the estimated effect."

In another report in the journal, online the same day, Dr. David L. Leaper from the University of Huddersfield in the U.K. and colleagues estimated the potential health service and budget impacts following wound closure with TCS or non-coated sutures for the National Health Service (England) as a healthcare provider.

According to their meta-analysis of 34 studies, the use of TCS is associated with a mean savings per operation ranging from £56.59 (67 euros, US$71) for clean wound procedures to £248.23 (293 euros, $313) for contaminated/dirty wound operations, with overall savings per operation of £91.25 (108 euros, $115).

The savings were based on a 39% reduction in SSI associated with TCS in these studies.

"Several independent systematic reviews and meta-analyses are saying the same thing: that antimicrobial sutures reduce surgical site infections by 30%," Dr. Leaper told Reuters Health. "Some skepticism is still held by a small minority but this new study shows unequivocally that not only do antimicrobial sutures reduce SSI, but that they also have a huge potential economic health care saving."

"Their use should be included in surgical care bundles in all operations," he said. "There would be no need to check compliance in the use of care bundles if they replaced conventional sutures. Antimicrobial sutures are entirely safe with no reported safety issues."

"This is level 1A evidence of efficacy," Dr. Leaper concluded. "No further debate of their use and efficacy and savings needs to be undertaken."

Dr. Boermeester did not respond to a request for comments. One of the three authors of the second report is employed by Johnson & Johnson, and an epidemiologist from Johnson & Johnson assisted in that study. Dr. Boermeester has received grants from Johnson & Johnson outside the current research.


Br J Surg 2017.


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