Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Mar 3;8(3):e250306.
doi: 10.1001/jamanetworkopen.2025.0306.

Triclosan-Containing Sutures for the Prevention of Surgical Site Infection: A Systematic Review and Meta-Analysis

Hasti Jalalzadeh  1   2   3 , Allard S Timmer  1   2 , Dennis R Buis  3   4 , Yasmine E M Dreissen  3   4 , Jon H M Goosen  3   5 , Haitske Graveland  3   6 , Mitchel Griekspoor  3   6 , Frank F A IJpma  3   7 , Maarten J van der Laan  3   7 , Roald R Schaad  3   8   9 , Patrique Segers  3   10 , Wil C van der Zwet  3   11 , Stijn W de Jonge  1   2 , Niels Wolfhagen  1   2   3 , Marja A Boermeester  1   2   3
Affiliations
Meta-Analysis

Triclosan-Containing Sutures for the Prevention of Surgical Site Infection: A Systematic Review and Meta-Analysis

Hasti Jalalzadeh et al. JAMA Netw Open. .

Abstract

Importance: International guidelines recommend the use of triclosan-containing sutures for the prevention of surgical site infections. However, controversy still 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 previous published review in 2017. A meta-analysis of 31 studies including 17 968 participants (62% male) undergoing various types of surgery was performed. 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.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Boermeester reported receiving institutional funding from Johnson & Johnson for a nonrelated study and consultant fees from Solventum, Telabio, BD, Smith & Nephew, Molnlycke, and Angiodynamics outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Preferred Reporting Items for Systematic Reviews and Meta-Analyses Flow Diagram of Study Selection
PICO indicates population, intervention, comparison, and outcome; RCT, randomized clinical trial.
Figure 2.
Figure 2.. Forest Plot for the Primary Outcome of Surgical Site Infection
NIHR indicates National Institute for Health and Care Research; RR, relative risk; SSI, surgical site infection.
Figure 3.
Figure 3.. Results of Primary Outcome, Secondary Outcomes, Sensitivity, and Subgroup Analyses
NA indicates not applicable; RR, relative risk; SSI, surgical site infection.
See this image and copyright information in PMC

References

    1. National Healthcare Safety Network . Surgical Site Infection Event (SSI). Centers for Disease Control and Prevention. Published January 2023. Accessed August 15, 2024. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf
    1. Anderson DJ, Podgorny K, Berríos-Torres SI, et al. . Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(6):605-627. doi:10.1086/676022 - DOI - PMC - PubMed
    1. Henry-Stanley MJ, Hess DJ, Barnes AM, Dunny GM, Wells CL. Bacterial contamination of surgical suture resembles a biofilm. Surg Infect (Larchmt). 2010;11(5):433-439. doi:10.1089/sur.2010.006 - DOI - PMC - PubMed
    1. Kathju S, Nistico L, Tower I, Lasko LA, Stoodley P. Bacterial biofilms on implanted suture material are a cause of surgical site infection. Surg Infect (Larchmt). 2014;15(5):592-600. doi:10.1089/sur.2013.016 - DOI - PMC - PubMed
    1. Barbolt TA. Chemistry and safety of triclosan, and its use as an antimicrobial coating on Coated VICRYL* Plus Antibacterial Suture (coated polyglactin 910 suture with triclosan). Surg Infect (Larchmt). 2002;3(suppl 1):S45-S53. doi:10.1089/sur.2002.3.s1-45 - DOI - PubMed

Publication types

MeSH terms