title: Antimicrobial-coated sutures to decrease surgical site infections: a systematic review and meta-analysis.
abstract: To investigate the effectiveness of antimicrobial-coated sutures compared with non-coated sutures in reducing surgical site infection (SSI) and develop recommendations for World Health Organization (WHO) SSI prevention guidelines. We searched Medline, Embase, Cinahl, Cochrane Central Register of Controlled Trials, and WHO Global Health from 1990-16/02/2015 with language restricted to English, Spanish, and French. Meta-analysis was performed with a random-effects model. Meta-regression analysis assessed whether the effect of antimicrobial coating changed according to the type of suture and surgery. Subgroup analyses were based on types of sutures. Quality of the retrieved evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation. Thirteen randomized controlled trials (RCTs) and five observational studies (OBSs) met the inclusion criteria. Antimicrobial sutures significantly reduced SSI risk (for RCTs: OR 0.72, 95 % CI 0.59-0.88, p = 0.001, I2= 14 %; for OBSs: OR 0.58, 95 % CI 0.40-0.83, p = 0.003, I2= 22 %). Only Vicryl Plus vs Vicryl revealed consistent results in favor of antimicrobial sutures (for seven RCTs: OR 0.62, 95 % CI 0.44-0.88, p = 0.007, I2= 3 %; for four OBSs: OR 0.58, 95 % CI 0.37-0.92, p = 0.02, I2= 41 %). The effect of antimicrobial coating was similar between different suture, wound, and procedure types. Quality of RCT evidence was moderate, and OBS evidence was very low quality. Triclosan-coated sutures may reduce SSI risk. However, the available evidence is of moderate/low quality, and many studies had conflicts of interest.
authors: Department of Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China.
authors: X
authors: X
authors: Wu
authors: Infection Prevention and Control Unit, Department of Service Delivery & Safety, World Health Organization, Geneva, Switzerland.
authors: N Z
authors: NZ
authors: Kubilay
authors: Department of Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China. JiananR@gmail.com.
authors: J
authors: J
authors: Ren
authors: Infection Prevention and Control Unit, Department of Service Delivery & Safety, World Health Organization, Geneva, Switzerland.
authors: B
authors: B
authors: Allegranzi
authors: Institute of Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Berlin, Germany.
authors: P
authors: P
authors: Bischoff
authors: Infection Prevention and Control Unit, Department of Service Delivery & Safety, World Health Organization, Geneva, Switzerland.
authors: B
authors: B
authors: Zayed
authors: Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors: D
authors: D
authors: Pittet
authors: Department of Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China.
authors: J
authors: J
authors: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D020099:Coated Materials, Biocompatible / Q000737:chemistry*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*; D013536:Suture Techniques; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents; D020099:Coated Materials, Biocompatible