title: The Effect of Antibiotic-Coated Sutures on the Incidence of Surgical Site Infections in Abdominal Closures: a Meta-Analysis.
abstract: OBJECTIVE
  This meta-analysis aims to determine if antibiotic-impregnated sutures for abdominal fascial closure prevent postoperative surgical site infections (SSIs), hernias, and/or dehiscence.
  
  
  METHODS
  MEDLINE and EMBASE databases (1946-2016) were searched. Randomized controlled trials comparing antibiotic-impregnated sutures to standard sutures for abdominal closure were eligible. Risk of bias was evaluated using the Cochrane Handbooks definitions.
  
  
  RESULTS
  Four-hundred fifty articles were reviewed; five eligible studies (N = 3117) were identified. All studies routinely used prophylactic antibiotics. Overall risk of SSI in the antibiotic-impregnated suture group was 10.4 vs. 13.0% in the control group. Pooled data showed no difference in SSI between suture types (odds ratio 0.79, 95% CI 0.57-1.09, P = 0.15, I2= 44%). There was no evidence of subgroup effect by suture material (polydioxanone vs. polyglactin 910; P = 0.19) or by comparing colorectal surgery studies to others (P = 0.67). There was a high risk of bias in two studies, one for high loss to follow-up and one for not using an intent-to-treat analysis.
  
  
  CONCLUSIONS
  Our meta-analysis is the most comprehensive review on the utility of antibiotic-impregnated sutures in abdominal surgery to prevent SSI. We found no evidence to support routine use of these sutures.
authors.affiliation: Queen's University School of Medicine, Kingston, ON, Canada.
authors.forename: Basheer
authors.identifier: http://orcid.org/0000-0003-2078-5821
authors.initials: B
authors.lastname: Elsolh
authors.affiliation: Department of Surgery, Kingston General Hospital, 76 Stuart Street, Burr 2, Kingston, ON, K7L 2V7, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Surgery, Kingston General Hospital, 76 Stuart Street, Burr 2, Kingston, ON, K7L 2V7, Canada. patels2@kgh.kari.net.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Patel
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D058107:Abdominal Wound Closure Techniques / Q000009:adverse effects / Q000295:instrumentation*; D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D013505:Digestive System Surgical Procedures; D046449:Hernia, Abdominal / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D016032:Randomized Controlled Trials as Topic; D013529:Surgical Wound Dehiscence / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D013537:Sutures
chemical_list: D000900:Anti-Bacterial Agents
keywords: Abdominal closure; Antibiotic-coated sutures; Patient outcomes; SSI