Surgical Infection Society Guidelines for Use of Antimicrobial Agent-Coated Suture to Reduce the Risk of Surgical Site Infection after Abdominal Operation

Abstract

Background: Abdominal operation is common as are surgical site infections (SSIs). Triclosan (polychlorophenoxyphenol) is an antimicrobial antiseptic used in a variety of consumer products, including suture. The Surgical Infection Society's Therapeutics and Guidelines Committee convened to perform a systematic review and develop pragmatic recommendations for use of triclosan-coated suture in prevention of SSI after an abdominal surgical procedure. Methods: A research librarian designed and performed searches of three bibliographic databases: PubMed, Embase, and Web of Science. Methodology for this practice management guideline conformed to Reporting Items for practice Guidelines in HealThcare Working Group standards. Covidence was used for study selection and quality and certainty of published evidence was evaluated using GRADE. The clinical question assessed was: "For adult patients undergoing abdominal surgery, does triclosan-coated suture vs. non-triclosan-coated suture reduce the risk of post-operative SSI?" Results: A total of 3,616 studies were identified, with 30 studies involving 97,807 patients informing the clinical question response. Among included studies, 13 (43%) were randomized controlled trials (RCTs) and 17 (57%) were meta-analyses. Seventeen (57%) studies comprising 67,445 (69%) patients demonstrated reduction in SSI, with 13 (43%) studies comprising 30,362 (31%) patients demonstrating no benefit. Estimated cumulative adjusted absolute risk reduction associated with triclosan-coated sutures, among studies demonstrating benefit, was 3.2% (standard deviation ±6.2%). Overall quality of evidence was high. We recommend triclosan-coated suture for incision closure after an abdominal operation to reduce risk of SSI (Grade 1A). Conclusions: Higher-level evidence suggests a small but significant benefit for triclosan-coated suture in reducing SSI risk following an abdominal surgical procedure.

Keywords: infection; pain; surgery; suture; triclosan.