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

Summary

Pooling 31 RCTs (n=17,968), triclosan-coated sutures reduced surgical site infections versus non-coated analogs (RR 0.75, 95% CI 0.65–0.86), with moderate certainty. Trial sequential analysis indicated the accumulated evidence is robust and unlikely to be reversed by future trials.

Key Findings

• Across 31 RCTs (n=17,968), triclosan-containing sutures reduced SSI (RR 0.75; 95% CI 0.65–0.86).
• Moderate heterogeneity (I2=43%; τ2=0.04) and moderate certainty of evidence (GRADE).
• Trial sequential analysis showed the monitoring boundary for benefit was crossed, indicating robustness.
• Sensitivity analysis excluding high risk-of-bias trials preserved the benefit.

Clinical Implications

Adopt triclosan-coated sutures as default for wound closure in most surgeries to reduce SSI, barring specific contraindications or supply constraints. Incorporate into ERAS and infection prevention bundles.

Limitations

• Clinical heterogeneity across procedures and settings
• Moderate certainty due to heterogeneity; surgical technique and infection control practices vary

Future Directions

Cost-effectiveness analyses by specialty and setting; implementation studies integrating triclosan sutures into standardized bundles; surveillance for resistance or unforeseen adverse events.