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Triclosan-Coated Sutures Ineffective in Reducing Surgical-Site Infections

Summary and Comment |
April 22, 2014

Triclosan-Coated Sutures Ineffective in Reducing Surgical-Site Infections

  1. Mary E. Wilson, MD

In a large, multicenter trial, using triclosan-coated sutures instead of standard ones for fascia closure after open abdominal surgery did not reduce postoperative surgical-site infections.

  1. Mary E. Wilson, MD

Surgical-site infections are common after abdominal surgery, occurring in 12% to 16% of patients undergoing midline laparotomy. In the manufacturer-supported, multicenter, randomized PROUD (Prevention of Abdominal Wound Infection) trial, researchers compared infection rates between triclosan-coated sutures and noncoated ones. Triclosan interferes with microbial lipid synthesis, which confers broad antibacterial activity.

At 24 hospitals in Germany, adults undergoing elective midline abdominal laparotomy were randomized to triclosan-coated polydioxanone (PDS Plus) or standard polydioxanone (PDS II) sutures for fascia closure. Surgeons, patients, and outcome assessors were blinded to group assignment. Assessment for wound infection was done on day 10 (or at discharge, if earlier) and day 30. Among the 1185 patients in the modified intention-to-treat population, 98% received antibiotic prophylaxis; 62% were male.

Surgical-site infection within 30 days was similar between groups (14.8% for PDS Plus and 16.1% for PDS II), as was the proportion of infections that were deep. Secondary endpoints, (including frequency of wound dehiscence and duration of hospital stay) and the reported rate of serious adverse events were also similar between groups.

The authors also undertook a meta-analysis of published randomized trials comparing triclosan-coated versus standard sutures. The aggregated results, not including those of the PROUD trial, showed a significant superiority of triclosan-coated sutures. With inclusion of PROUD, the results still suggested significant effectiveness of triclosan-coated sutures.

Comment

The authors note that surgical-site infections are related to patient-dependent (e.g., diabetes, obesity) and surgery-dependent factors. The latter are more amenable to innovative interventions. Their meta-analysis results notwithstanding, the authors emphasize the validity and strength of this study and describe deficiencies in others. An editorialist notes that despite initial enthusiasm about anti-infective–treated or –impregnated devices, substantial uncertainty remains regarding their benefit. He and the authors point to the need for large, well-designed trials that assess effectiveness in subgroups, such as high-risk patients.

  • Disclosures for Mary E. Wilson, MD at time of publication Editorial boards UptoDate; Clinical Infectious Diseases; RSTMH International Health; Infectious Diseases in Clinical Practice; Travel Medicine and Infectious Diseases

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