The use of triclosan-coated sutures to prevent surgical site infections: a systematic review and meta-analysis of the literature

Ahmed, Imran; Boulton, A; Rizvi, Sana; Carlos, W. Graham; Dickenson, Edward; Smith, Nick; Reed, Mike

doi:10.1136/bmjopen-2019-029727

Cited by 100 publications

(84 citation statements)

References 62 publications

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“…Research regarding triclosan-coated sutures is of interest. Although our own work looking at infection rates with this type of suture showed no benefit compared with standard sutures, a large meta-analysis shows a definite benefit of triclosan sutures, 91 and although more expensive, there is an overall cost saving in relation to a reduced infection rate. 119 We have not yet incorporated triclosan-coated sutures into our practice but plan to do so, based on this evidence.…”

Section: Discussionmentioning

confidence: 71%

“… 90 More recently, we performed a meta-analysis incorporating 25 RCTs and 11,957 patients showed that triclosan-coated sutures significantly reduced the rate of SSI at 30 days (RR 0.73, 95% CI 0.65–0.82). 91 Ten RCTs within this meta-analysis were focused on clean surgery, for which a significantly lower incidence of SSI (149/3029) occurred with triclosan-coated sutures compared to standard sutures (230/1117) (RR 0.71, 95% CI 0.58–0.88). We estimate that the prevention of one SSI saves around £2000 in joint replacement costs – and as such is highly cost-effective.…”

Section: Suture Materialsmentioning

confidence: 99%

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Prevention of infection in primary THA and TKA

Dobson

Reed

2020

EFORT Open Reviews

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Rates of peri-prosthetic joint infection (PJI) in primary total hip and total knee arthroplasty range between 0.3% and 1.9%, and up to 10% in revision cases. Significant morbidity is associated with this devastating complication, the economic burden on our healthcare system is considerable, and the personal cost to the affected patient is immeasurable. The risk of surgical site infection (SSI) and PJI is related to surgical factors and patient factors such as age, body mass index (BMI), co-morbidities, and lifestyle. Reducing the risk of SSI in primary hip and knee arthroplasty requires a multi-faceted strategy including pre-operative patient bacterial decolonization, screening and avoidance of anaemia, peri-operative patient warming, skin antisepsis, povidone-iodine wound lavage, and anti-bacterial coated sutures. This article also considers newer concepts such as the influence of bearing surfaces on infection risk, as well as current controversies such as the potential effects of blood transfusion, laminar flow, and protective hoods and suits, on infection risk. Cite this article: EFORT Open Rev 2020;5:604-613. DOI: 10.1302/2058-5241.5.200004

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Section: Discussionmentioning

confidence: 71%

Section: Suture Materialsmentioning

confidence: 99%

Prevention of infection in primary THA and TKA

Dobson

Reed

2020

EFORT Open Reviews

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“…Sensitivity analysis also documented a significant SSI reduction benefit for clean, clean-contaminated, and contaminated surgical procedures. 35 …”

Section: Discussionmentioning

confidence: 99%

Assessment of the Risk and Economic Burden of Surgical Site Infection Following Colorectal Surgery Using a US Longitudinal Database: Is There a Role for Innovative Antimicrobial Wound Closure Technology to Reduce the Risk of Infection?

Leaper

Holy

Spencer³

et al. 2020

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Colorectal surgical procedures place substantial burden on health care systems because of the high complication risk, of surgical site infections in particular. The risk of surgical site infection after colorectal surgery is one of the highest of any surgical specialty. OBJECTIVE: The purpose of this study was to determine the incidence, cost of infections after colorectal surgery, and potential economic benefit of using antimicrobial wound closure to improve patient outcomes. DESIGN: Retrospective observational cohort analysis and probabilistic cost analysis were performed. SETTINGS: The analysis utilized a database for colorectal patients in the United States between 2014 and 2018. PATIENTS: A total of 107,665 patients who underwent colorectal surgery were included in the analysis. MAIN OUTCOME MEASURES: Rate of infection was together with identified between 3 and 180 days postoperatively, infection risk factors, infection costs over 24 months postoperatively by payer type (commercial payers and Medicare), and potential costs avoided per patient by using an evidence-based innovative wound closure technology. RESULTS: Surgical site infections were diagnosed postoperatively in 23.9% of patients (4.0% superficial incisional and 19.9% deep incisional/organ space). Risk factors significantly increased risk of deep incisional/organ-space infection and included several patient comorbidities, age, payer type, and admission type. After 12 months, adjusted increased costs associated with infections ranged from $36,429 to $144,809 for commercial payers and $17,551 to $102,280 for Medicare, depending on surgical site infection type. Adjusted incremental costs continued to increase over a 24-month study period for both payers. Use of antimicrobial wound closure for colorectal surgery is projected to significantly reduce median payer costs by $809 to $1170 per patient compared with traditional wound closure. LIMITATIONS: The inherent biases associated with retrospective databases limited this study. CONCLUSIONS: Surgical site infection cost burden was found to be higher than previously reported, with payer costs escalating over a 24-month postoperative period. Cost analysis results for adopting antimicrobial wound closure aligns with previous evidence-based studies, suggesting a fiscal benefit for its use as a component of a comprehensive evidence-based surgical care bundle for reducing the risk of infection. See Video Abstract at http://links.lww.com/DCR/B358. EVALUACIÓN DEL RIESGO Y LA CARGA ECONÓMICA DE LA INFECCIÓN DEL SITIO QUIRÚRGICO DESPUÉS DE UNA CIRUGÍA COLORRECTAL UTILIZANDO UNA BASE DE DATOS LONGITUDINAL DE EE.UU.: ¿EXISTE UN PAPEL PARA LA TECNOLOGÍA INNOVADORA DE CIERRE DE HERIDAS ANTIMICROBIANAS PARA REDUCIR EL RIESGO DE INFECCIÓN? ANTECEDENTES: Los procedimientos quirúrgicos colorrectales suponen una carga considerable para los sistemas de salud debido al alto riesgo de complicaciones, particularmente las infecciones del sitio quirúrgico. El riesgo de infección posoperatoria del sitio quirúrgico colorrectal es uno de los más altos de cualquier especialidad quirúrgica. OBJETIVO: El propósito de este estudio fue determinar la incidencia, el costo de las infecciones después de la cirugía colorrectal y el beneficio económico potencial del uso del cierre de la herida con antimicrobianos para mejorar los resultados de los pacientes. DISEÑO: Análisis retrospectivo de cohorte observacional y análisis de costo probabilístico. AJUSTES: El análisis utilizó la base de datos para pacientes colorrectales en los Estados Unidos entre 2014 y 2018. PACIENTES: Un total de 107,665 pacientes sometidos a cirugía colorrectal. PRINCIPALES MEDIDAS DE RESULTADO: Se identificó una tasa de infección entre 3 y 180 días después de la operación, los factores de riesgo de infección, los costos de infección durante 24 meses posteriores a la operación por tipo de pagador (pagadores comerciales y Medicare), y los costos potenciales evitados por paciente utilizando una tecnología innovadora de cierre de heridas basada en evidencias. RESULTADOS: Infecciones del sitio quirúrgico, diagnosticadas postoperatoriamente en el 23,9% de los pacientes (4,0% incisional superficial y 19,9% incisional profunda / espacio orgánico). Los factores de riesgo aumentaron significativamente el riesgo de infección profunda por incisión / espacio orgánico e incluyeron comorbilidades selectivas del paciente, edad, tipo de pagador y tipo de admisión. Después de 12 meses, el aumento de los costos asociados con las infecciones varió de $ 36,429 a $ 144,809 para los pagadores comerciales y de $ 17,551 a $ 102,280 para Medicare, según el tipo de infección del sitio quirúrgico. Los costos incrementales ajustados continuaron aumentando durante un período de estudio de 24 meses para ambos pagadores. Se prevé que el uso del cierre antimicrobiano de la herida para la cirugía colorrectal reducirá significativamente los costos medios del pagador en $ 809- $ 1,170 por paciente en comparación con el cierre tradicional de la herida. LIMITACIONES: Los sesgos inherentes asociados a las bases de datos retrospectivas limitaron este estudio. CONCLUSIONES: Se encontró que la carga del costo de la infección del sitio quirúrgico es mayor que la reportada previamente, y los costos del pagador aumentaron durante un período postoperatorio de 24 meses. Los resultados del análisis de costos para la adopción del cierre de heridas antimicrobianas se alinean con estudios previos basados en evidencia, lo que sugiere un beneficio fiscal para su uso como componente de un paquete integral de atención quirúrgica basada en evidencia para reducir el riesgo de infección. Consulte Video Resumen en http://links.lww.com/DCR/B358.

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“…Available varieties of triclosan‐coated suture material include Vicryl Plus, Monocryl Plus and PDS Plus Antibacterial sutures . A recent systematic review and meta‐analysis concluded that triclosan‐coated sutures were effective in reducing surgical site infections . The World Health Organization and Centers for Disease Control and Prevention guidelines for the prevention of surgical site infection recommend the use of triclosan‐coated sutures, based on low‐to‐moderate quality evidence…”

Section: Discussionmentioning

confidence: 99%

“…3 A recent systematic review and meta-analysis concluded that triclosan-coated sutures were effective in reducing surgical site infections. 4 The World Health Organization and Centers for Disease Control and Prevention guidelines for the prevention of surgical site infection recommend the use of triclosan-coated sutures, based on low-to-moderate quality evidence. 5,6 Triclosan has a low sensitizing potential and ACD is uncommon.…”

mentioning

confidence: 99%