Triclosan-Coated Sutures Reduce the Risk of SSI

Three globally recognized health authorities now recommend the use of triclosan-coated sutures for surgical site infection (SSI) prevention. *The CDC, WHO, and ACS/SIS guidelines on reducing the risk of SSI are general to triclosan-coated sutures and are not specific to any one brand.

Triclosan-coated sutures reduce the risk of SSI
ACS Icon

“Consider the use of triclosan-coated sutures for the prevention of SSI”*1

Centers for Disease Control and Prevention (CDC)

WHO Icon

The panel suggests the use of triclosan coated sutures for the purpose of reducing the risk of SSI, independent of the type of surgery”*2

World Health Organization (WHO)

CDC Icon

“The use of triclosan coated suture is recommended for wound closure in clean and clean-contaminated abdominal cases when available”*3

American College of Surgeons & Surgical Infection Society (ACS & SIS)

The Results Are In

Determining triclosan-coated sutures' ability to help reduce the risk of SSI is the subject of a wealth of clinical evidence, including 10 meta-analyses of 24 randomized controlled trials involving over 7,000 patients.4-14

The results are in

You Can’t Tell the Difference, but Bacteria Can.

Sutures, like any foreign material, lower the number of bacteria required to cause an infection; and the biofilm formed on the suture can actually protect bacteria against infection fighting cells and antibiotic therapy.  Ethicon responded by creating Plus Antibacterial Sutures. Shown in vitro to inhibit bacterial colonization of the suture for 7 days or more, Plus Sutures are a simple way to address a known risk factor for SSI.31-36

You can’t tell the difference, but bacteria can.
Understanding the Plus Antibacterial Technology

Shown in vitro to inhibit bacterial colonization of the suture for 7 days or more, Plus Sutures are a simple way to address a known risk factor for SSI.³¹-³⁶

References

1. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. doi:10.1001/jamasurg.2017.0904. 

2. WHO Global Guidelines for the Prevention of Surgical Site Infection, 2016. 

3. Ban KA, Minei JP, Laronga C, et al. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg. 2016;224:59-74. 

4. Apisarnthanarak A, Singh N, Bandong AN, et al. Triclosan-Coated Sutures Reduce the Risk of Surgical Site Infections: A Systematic Review and Meta-Analysis. Infection Control & Hospital Epidemiology 2015;36:169179. 

5. Chang WK, Srinivasa S, Morton R, et al. Triclosan-Impregnated Sutures to Decrease Surgical Site Infections: Systematic Review and Meta-Analysis of Randomized Trials. Ann Surg 2012; 255:854859. 

6. Daoud FC, Edmiston CE Jr, Leaper D. Meta-analysis of prevention of surgical site infections following incision closure with triclosan-coated sutures: Robustness to new evidence. Surg Infect (Larchmt) 2014;15:165181. 

7.. Daoud FC. Systematic Literature Review Update of the PROUD Trial: Potential Usefulness of a Collaborative Database. Letter to Surg Infect (Larchmt) 2014;15:857858. 

8. Edmiston CE, Daoud FC, Leaper D. Is there an evidence-based argument for embracing an antimicrobial (triclosan)-coated suture technology to reduce the risk for surgical-site infections?: A meta-analysis. Surgery 2013;154:89100. 

9. Guo J, Pan LH, Li YX, et al. Efficacy of triclosan-coated sutures for reducing risk of surgical site infection in adults: a meta-analysis of randomized clinical trials. J Surg Res 2016; 201:105117.
 
10. Sajid MS, Craciunas L, Sains P, et al. Use of antibacterial sutures for skin closure in controlling surgical site infections: a systematic review of published randomized, controlled trials. Gastroenterol Rep 2013;1:4250. 

11. Sandini M, Mattavelli I, Nespoli L, Uggeri F, Gianotti L. Systematic review and meta-analysis of sutures coated with triclosan for the prevention of surgical site infection after elective colorectal surgery according to the PRISMA statement. Medicine. 2016;95:35(e4057). 

12. Wang ZX, Jiang CP, Cao Y, et al. Systematic review and meta-analysis of triclosan-coated sutures for the prevention of surgical-site infection. Brit J Surg 2013;100:465473. 

13.Wu X, Kubilay NZ, Ren J, et al. Antimicrobial-coated sutures to decrease surgical site infections: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis. 2016. DOI: 10.1007/s10096_016_2765-y. 

14. de Jonge SW, Atema JJ, Solomkin JS, Boermeester MA. Meta-analysis and trial sequential analysis of triclosan-coated sutures for the prevention of surgical site infection. Brit J Surg. 2017;ePub-DOI: 10.1002/bjs.10445.

15. 100326296: Time Zero Tissue Holding - Competitive Claims Comparisons for STRATAFIX Knotless Tissue Control Devices vs Various Products. 2015.

16. Performance Testing of STRATAFIX SYMMETRIC PDS PLUS Size 0 & 1 Devices – Initiation Strength in Porcine Tissue. AST-2013-0603. 

17. AST-2013-0056 Performance Testing of STRATAFIX Symmetric PDSSize2-0 suture device for Tissue Holding Strength with Multiple Incision Defects to Measure Gapping.

18. Ethicon study PSE 09-0204, project number 11822. Exploratory histological and biomechanical evaluation of DOLFIN following closure of the ventral abdominal wall in a porcine model at 7±1 days. Approved on July 7, 2010. 

19. Ethicon Performance Evaluation Memo AST-2012-0510. Performance Testing of STRATAFIX Symmetric Size 2-0 suture device for Tissue Holding Strength with an Incision Defect to Measure Gapping. Dated December 3, 2012. 

20. STRATAFIX Symmetric PDS Plus Knotless Tissue Control Device. Instructions for Use. Ethicon, Inc. 

21. Moran ME, Marsh C, Perrotti M. Bidirectional-barbed sutured knotless running anastomosis v classic Van Velthoven suturing in a model system. J Endourol. 2007;21(10):1175-1178. 

22. Vakil JJ, O’Reilly MP, Sutter EG, Mears SC, Belkoff SM, Khanuja HS. Knee arthrotomy repair with a continuous barbed suture: a biomechanical study. J Arthroplasty. 2011;26(5):710-713. 

23. Eickmann T, Quane E. Total knee arthroplasty closure with barbed sutures. J Knee Surg. 2010;23(3):163-167. 

24. Levine BR, Ting N, Della Valle CJ. Use of a barbed suture in the closure of hip and knee arthroplasty wounds. Orthopedics. 2011;34(9):e473-e475. doi: 10.3928/01477447-20110714-35.

25. Einarsson JI, Chavan NR, Suzuki Y, Jonsdottir G, Vellinga TT, Greenberg JA. Use of bidirectional barbed suture in laparoscopic myomectomy: evaluation of perioperative outcomes, safety, and efficacy. J Minim Invasive Gynecol. 2011;18 (1):92-95. 

26. Coated VICRYL Plus Antibacterial (polyglactin 910) Sutures Instructions for Use. Ethicon, Inc. 

27. MONOCRYL Plus Antibacterial (poliglecaprone 25) Suture Instructions for Use. Ethicon, Inc.

28. Ming X, Rothenburger S, Yang D. In vitro antibacterial efficacy of Monocryl Plus Antibacterial Suture (poliglecaprone 25 with triclosan). Surg Infect. 2007;8(2):201-207

29. Rothenburger S, Spangler D, Bhende S, Burkley D. In vitro antimicrobial evaluation of coated Vicryl Plus Antibacterial Suture (coated polyglactin 910 with triclosan) using zone of inhibition assays. Surg Infect. 2002;3(suppl1):S79-S87

30. Ming X, Rothenburger S, Nicholos MM. In vivo and in vitro antibacterial efficacy of PDS Plus (polidioxanone with triclosan) suture. Surg. Infect 2008;9(4):451-457 

31. Hendley JO, Ashe KM. Effect of topical antimicrobial treatment on aerobic bacteria in the stratum corneum of human skin. Antimicrobial Agents and Chemotherapy. 1991;35(4):627-631. 

32. Ward KH, Olson ME, Lam K, Costerton JW. Mechanism of persistent infection associated with peritoneal implants. J Med Microbiol. 1992;36(6):406-413.   

33. Kathju S, Nistico L, Hall-Stoodley L, et al. Chronic surgical site infection due to suture-associated polymicrobial biofilm. Surg Infect (Larchmt). 2009;10(5):457-461.

34. Rothenburger S, Spangler D, Bhende S, Burkely D. In vitro antimicrobial evaluation of Coated VICRYL* Plus Antibacterial Suture (coated polyglactin 910 with triclosan) using zone of inhibition assays. Surg Infect (Larchmt). 2002;3(Suppl 1):S79-S87.

35. Ming X, Rothenburger S, Yang D. In vitro antibacterial efficacy of MONOCRYL plus antibacterial suture (poliglecaprone 25 with triclosan). Surg Infect (Larchmt). 2007;8(2):201-207.

36. Ming X, Rothenburger S, Nichols M. In vivo and in vitro antibacterial efficacy of PDS plus (polidioxanone with triclosan) suture. Surg Infect (Larchmt). 2008;9(4):451-457.

For complete indications, contraindications, warnings, precautions, and adverse reactions, please reference full package insert.