Triclosan-coated sutures reduce surgical site infection after open vein harvesting in coronary artery bypass grafting patients: a randomized controlled trial†

Abstract

OBJECTIVESThe incidence of surgical site infection (SSI) after open vein harvesting in coronary artery bypass grafting (CABG) patients ranges in different studies between 2 and 20%. Triclosan is an antibacterial substance that reduces the growth of bacteria by inhibiting fatty acid synthesis. We hypothesized that wound closure with triclosan-coated sutures would reduce SSI after open vein harvesting.METHODSAn investigator-initiated prospective randomized double-blind single-centre study was performed with 374 patients, randomized to subcutaneous and intracutaneous leg-wound closure with either triclosan-coated sutures (Vicryl Plus® and Monocryl Plus®, Ethicon, Somerville, NJ, USA) (n = 184) or identical sutures without triclosan (n = 190) from the same manufacturer. All patients were followed up after 30 days (clinical visit) and 60 days (telephone interview). Primary endpoint was SSI within 60 days after surgery according to the definition of Center for Disease Control. Predefined secondary endpoints included culture-proven and antibiotic-treated SSI.RESULTSThe primary endpoint occurred in 23 patients (12.5%) with triclosan-coated sutures and in 38 patients (20.0%) in the group without triclosan (P = 0.0497, risk ratio 0.63, (95% confidence interval 0.39–1.00). Corresponding figures for culture-proven infections were 7.6 vs 12.1%, (P = 0.15), and for antibiotic-treated infections, 10.9 vs 18.4%, (P = 0.039). Staphylococcus aureus and coagulase-negative staphylococci were the most common pathogens in both groups. Insulin-treated diabetes and vein-harvesting time were associated with SSI after vein harvesting.CONCLUSIONSLeg-wound closure with triclosan-coated sutures in CABG patients reduces SSIs after open vein harvesting. (ClinicalTrials.gov number NCT01212315).

Association between Triclosan-Coated Sutures for Abdominal Wall Closure and Incisional Surgical Site Infection after Open Surgery in Patients Presenting with Fecal Peritonitis: A Randomized Clinical Trial

“…Pre-clinical studies have shown that triclosan-coated sutures reduce the growth of gram-positive and gram-negative bacteria [9,10]. These studies have been followed by retrospective series and prospective controlled trials in different surgical populations to test whether triclosan-coated sutures reduce incisional SSIs; however, results have been conflicting.…”

Prävention postoperativer Wundinfektionen

“…Es könnte deshalb mit seiner Verwendung zur Reduktion des SSI-Risikos kommen. Die diesbezügliche Studienlage ist uneinheitlich [192][193][194][195][196][197][198][199][200][201]. Die WHO empfiehlt die Verwendung unabhängig von der Art der Operation [40], das CDC in der Viszeralchirurgie [202].…”

Comments on the Article: “Meta-Analysis of Prevention of Surgical Site Infections after Incision Closure with Triclosan-Coated Sutures: Robustness to New Evidence”

“…Thimour-Bergström et al [6] conducted a randomized double-blinded study including 374 coronary artery bypass surgery patients. They reported that leg surgical incision closure with triclosan-coated sutures reduces SSI rate after open vein harvesting.…”

“…This study, not included in the meta-analysis, reported that the occurrence of SSI after abdominal wall closure did not differ between the triclosan-coated group and the control group. The meta-analysis would have resulted with the conclusion that the use of triclosan-coated sutures does not decrease the incidence of SSI if the study by Diener et al [8] included in the analysis and the studies of Zhuang et al [2], Isik et al [7], and Thimour-Bergström et al [6] were interpreted as ''non-triclosan-favoring'' and the studies of Rasic et al [3] and Galal et al [5] were excluded from the analysis.…”