Clinical References Utilizing Antimicrobial Sutures

Antimicrobial formulation and delivery in the prevention of surgical site infection

O'Neal PB, Itani KM

"Proper dosing and re-dosing of prophylactic intravenous antibiotics should become standard practice. Continuation of intravenous antibiotic prophylaxis beyond wound closure is unnecessary in clean cases and remains controversial in clean-contaminated and complex cases. Oral antibiotic bowel preparation is an important adjunct to intravenous antibiotic prophylaxis in colorectal surgery. The use of topical antimicrobial and antiseptic agents such as antibacterial irrigations, local antimicrobial application, antimicrobial-coated sutures, antibacterial wound sealants, and antimicrobial impregnated dressings in the prevention of SSI is questionable."

Efficacy of triclosan-coated sutures for reducing risk of surgical site infection in adults: A meta-analysis of randomized clinical trials

Guo J, Pan LH, Li YX, Yang XD, Li LQ, Zhang CY, Zhong JH

"Triclosan-coated sutures can decrease the incidence of SSI in abdominal surgeries and might not interfere with wound healing process. Nevertheless, further studies are needed to examine whether triclosan-coated sutures are effective at preventing SSI in non-abdominal surgeries and to further study the interaction of antibiotic prophylaxis with triclosan-coated sutures."

Delayed wound dehiscence of anterior knee incisions in patients aged 20 years and younger: A comparison of subcutaneous skin closure

Salib CG, Smith JC, Siow N, Luhmann SJ

"The frequency of DWD in anterior knee incisions in our study population was 6.1% in the polyglactin 910 (Vicryl) group and 1.7% in the polydioxane (PDS) group. Although this analysis did not achieve statistical significance, a 3.5 times decrease in DWD when PDS was used is considered by the authors to be clinically significant. The authors have definitively switched from Vicryl to PDS for the subcutaneous skin closure at the knee in patients aged 20 years and younger in the push to make wound complications a nonevent."

Achieving and sustaining zero: Preventing surgical site infections after isolated coronary artery bypass with saphenous vein harvest site through implementation of a staff-driven quality improvement process

Kles CL, Murrah CP, Smith K, Baugus-Wellmeier E, Hurry T, Morris CD

"A significant reduction in deep sternal wound infections was achieved by working at all levels of the organization through a multidisciplinary approach to create sustained change. Using real-time observations for current practices, areas for improvement were identified. By engaging frontline staff in the process, ownership of the outcomes and adherence to practice change were promoted. The result was a dramatic, rapid, and sustainable improvement in the prevention of deep sternal wound infection."

Multi-center randomized controlled trial on the effect of triclosan-coated sutures on surgical site infection after colorectal surgery

Mattavelli I, Rebora P, Doglietto G, Dionigi P, Dominioni L, Luperto M, La Porta A, Garancini M, Nespoli L, Alfieri S, Menghi R, Dominioni T, Cobianchi L, Rotolo N, Soldini G, Valsecchi MG, Chiarelli M, Nespoli A, Gianotti L

"Surgical sutures coated with triclosan do not appear to be effective in reducing the rate of SSI."

Clinical and microbiological aspects of biofilm-associated surgical site infections

Edmiston CE Jr, McBain AJ, Roberts C, Leaper D

"The ideal method to manage a biofilm-mediated surgical site wound infection is to prevent it from occurring through rational use of antibiotic prophylaxis, adequate skin antisepsis prior to surgery and use of innovative in-situ irrigation procedures; together with antimicrobial suture technology in an effort to promote wound hygiene at the time of closure; once established, biofilm removal remains a significant clinical problem."

Antibacterial sutures for wound closure after surgery: A review of clinical and cost-effectiveness and guidelines for use [Internet]

"The reported clinical efficacy of antimicrobial sutures is inconsistent, with some systematic reviews reporting an overall benefit, while others do not. A previous CADTH report summarized evidence suggesting that TCS reduced SSIs compared to non-coated sutures. This report will provide an update and augment a recent CADTH Rapid Response reference list."

An economic model: Value of antimicrobial-coated sutures to society, hospitals, and third-party payers in preventing abdominal surgical site infections

Singh A, Bartsch SM, Muder RR, Lee BY

"Our results suggest that switching to triclosan-coated sutures from the uncoated sutures can both prevent SSIs and save substantial costs for hospitals, third-party payers, and society, as long as efficacy in preventing SSIs is at least 10% and SSI risk is at least 10%."

Effectiveness of triclosan-coated PDS Plus versus uncoated PDS II sutures for prevention of surgical site infection after abdominal wall closure: The randomised controlled PROUD trial

Diener MK, Knebel P, Kieser M, Schüler P, Schiergens TS, Atanassov V, Neudecker J, Stein E, Thielemann H, Kunz R, von Frankenberg M, Schernikau U, Bunse J, Jansen-Winkeln B, Partecke LI, Prechtl G, Pochhammer J, Bouchard R, Hodina R, Beckurts KT, Leißner L, Lemmens HP, Kallinowski F, Thomusch O, Seehofer D, Simon T, Hyhlik-Dürr A, Seiler CM, Hackert T, Reissfelder C, Hennig R, Doerr-Harim C, Klose C, Ulrich A, Büchler MW

"Triclosan-coated PDS Plus did not reduce the occurrence of surgical site infection after elective midline laparotomy. Innovative, multifactorial strategies need to be developed and assessed in future trials to reduce surgical site infections."

Surgical-site infection after abdominal wall closure with triclosan-impregnated polydioxanone sutures: Results of a randomized clinical pathway facilitated trial (NCT00998907)

Justinger C, Slotta JE, Ningel S, Gräber S, Kollmar O, Schilling MK

"This clinical pathway facilitated trial shows that triclosan impregnation of a 2-0 polydioxanone closing suture can decrease wound infections in patients having a laparotomy for general and abdominal vascular procedures."

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

Edmiston CE Jr, Daoud FC, Leaper D

"Decreasing the risk for SSIs requires a multifaceted 'care bundle' approach, and this meta-analysis of current, pooled, peer-reviewed, randomized controlled trials suggests a clinical effectiveness of antimicrobial-coated sutures (triclosan) in the prevention of SSIs, representing Center for Evidence-Based Medicine level 1a evidence."

Use of antibacterial sutures for skin closure in controlling surgical site infections: a systematic review of published randomized, controlled trials

Sajid MS, Craciunas L, Sains P, Singh KK, Baig MK

"Use of [Antibacterial Sutures] for skin closure in surgical patients is effective in reducing the risk of surgical site infection and postoperative complications. ABS is comparable with SS in terms of length of hospital stay and duration of operation."

Effect of Triclosan-Coated Sutures on the Incidence of Surgical Wound Infection After Lower Limb Revascularization Surgery: A Randomized Controlled Trial

Turtiainen J, Saimanen EI, Mäkinen KT, Nykänen AI, Venermo MA, Uurto IT, Hakala T

A prospective, randomized, multicenter, double-blinded trial including 276 patients undergoing lower limb revascularization surgery found that using triclosan-coated sutures does not reduce the incidence of surgical wound infection.

Incisional hernia after abdominal closure with slowly absorbable versus fast absorbable, antibacterial-coated sutures

Justinger C, Slotta JE, Schilling MK

A prospective, single center, investigator-driven study analyzed the effects of Triclosan-coated suture material (Vicryl plus) on the development of incisional hernia in 788 patients who had a primary midline incision for elective abdominal surgery. Fewer wound infections occurred in the Vicryl plus group than the PDS II looped suture group.

Efficiency of antibacterial suture material in cardiac surgery: a double-blind randomized prospective study

Isik I, Selimen D, Senay S, Alhan C

A double-blind, randomized, prospective study on the effect of antibacterial suture material on surgical site infection in 510 cardiac surgical patients found that the difference in sternal wound infection rates and the difference in leg wound infection rates between the coated suture groups and noncoated suture groups were not statistically significant. The study concluded that both noncoated and triclosan-coated suture materials are safe, but larger studies may be needed to show the benefit and cost-effectiveness, if any, of triclosan-coated suture materials over noncoated suture materials.

Surgical Site Infections after Abdominal Closure in Colorectal Surgery Using Triclosan-Coated Absorbable Suture (PDS Plus) vs. Uncoated Sutures (PDS II): A Randomized Multicenter Study

Baracs J, Huszár O, Sajjadi SG, Horváth ÖP

A randomized, multicenter, internet-based study involving seven surgical centers and 485 patients undergoing elective colorectal surgery found that there was a non-significant difference in SSI between the group having tricolosan-coated sutures and the group with uncoated sutures. The study could not confirm a beneficial effect of triclosan against gram-positive bacteria or show an effect against gram-negative enteric microorganisms.

Antimicrobial sutures and prevention of surgical site infection: assessment of the safety of the antiseptic triclosan

Leaper D, Assadian O, Hubner N-O, McBain A, Barbolt T, Rothenburger S, Wilson P

A review article based on a second Hygienist Panel meeting states that there is a strong rationale to use triclosan in surgical sutures, and many studies support the hypothesis that triclosan reduces the risk of surgical site infection associated with sutures.

Triclosan-coated sutures reduce wound infections after hepatobiliary surgery—a prospective non-randomized clinical pathway driven study

Justinger C, Schuld J, Sperling J, Kollmar O, Richter S, Schilling MK

A prospective, non-randomized, clinical pathway driven study representing 839 operations using a transverse abdominal incision concluded that antiseptic-coated loop Vicryl sutures for abdominal wall closure can be superior compared to PDS II sutures in reducing wound infection after a two-layered closure of transverse laparotomy.

Impact of using triclosan-antibacterial sutures on incidence of surgical site infection

Galal I, El-Hindawy K

A prospective, randomized, double-blinded, controlled, multicenter study representing 450 patients undergoing different surgical procedures concluded that using triclosan-coated polyglactin 910 antimicrobial sutures compared to conventional polyglactin 910 sutures led to the reduction of surgical site infection and could save $1,517,727 annually at the center where the study was conducted.

Efficacy of Antimicrobial Triclosan-Coated Polyglactin 910 (Vicryl* Plus) Suture for Closure of the Abdominal Wall after Colorectal Surgery

Rašić Ž, Schwarz D, Adam VN, Sever M, Lojo N, Rašić D, Matejić T

A study including 184 patients with colorectal cancer that compared the effect of triclosan coated polyglactin 910 (Vicryl* Plus) and polyglactin 910 (Vicryl*) on abdominal wall healing found that there were significantly fewer surgical site infections in the Vicryl* Plus group compared with the standard Vicryl* group.

Cosmetic outcome and surgical site infection rates of antibacterial absorbable (Polyglactin 910) suture compared to Chinese silk suture in breast cancer surgery: a randomized pilot research

Zhang Z-t, Zhang H-w, Fang X-d, Wang L-m, Li X-x, Li Y-f, Sun X-w, Carver J, Simpkins D, Shen J, Weisberg M

A randomized, multicenter, post-market, pilot study comparing the cosmetic outcome and incidence of surgical site infection of triclosan-coated VICRYL* Plus sutures with Chinese silk sutures for skin closure of modified radical mastectomy found that the use of coated VICRYL* Plus had better cosmetic outcomes as well as a lower incidence of surgical site infection, although the difference was not statistically significant.

Surgical Site Infection Prevention: How We Do It

Hranjec T, Swenson BR, Sawyer RG

An article on several different surgical site infection prevention measures for preoperative preparation, operating room conduct and postoperative wound care concluded that using antimicrobial-coated sutures shows promise in further reducing the risk of surgical site infection, although this is still unproven.

Efficacy of Antimicrobial Coating Suture Coated Polyglactin 910 with Tricosan (Vicryl Plus) Compared with Polyglactin 910 (Vicryl) in Reduced Surgical Site Infection of Appendicitis, Double Blind Randomized Control Trial, Preliminary Safety Report

Mingmalairak C, Ungbhakorn P, Paocharoen V

A primary report on the first 100 patients in a prospective, randomized, controlled, double blind, comparative, single center study evaluating the efficacy and safety of antibacterial suture (Vicryl Plus) compared with traditional braided suture (Vicryl) found that there was no statistical difference in surgical site infection after appendectomy.

Antibiotic coating of abdominal closure sutures and wound infection

Justinger C, Moussavian MR, Schlueter C, Kopp B, Kollmar O, Schilling MK

A study aiming to ascertain if the use of Vicryl Plus reduced the number of wound infections compared to polydioxanon suture (PDS II) concluded that using antibiotic-coated loop suture to close the abdominal wall can decrease the number of wound infections after midline laparotomy.

Triclosan-Coated Sutures for the Reduction of Sternal Wound Infections: Economic Considerations

Fleck T, Moidl R, Blacky A, Fleck M, Wolner E, Grabenwoger M, Wisser W

A study on triclosan-coated sutures for the closure of sternal incisions including 479 patients undergoing cardiac surgery concluded that triclosan-coated sutures might be a valuable approach to reduce sternal wound infections and avoid the suture being a risk factor for surgical site infection.

Intraoperative Handling and Wound Healing: Controlled Clinical Trial Comparing Coated VICRYL® Plus Antibacterial Suture (Coated Polyglactin 910 Suture with Triclosan) with Coated VICRYL® Suture (Coated Polyglactin 910 Suture)

Ford HR, Jones P, Gaines B, Reblock K, Simpkins DL

"A prospective, randomized, controlled, open-label, comparative, single-center study compared the intraoperative handling and wound healing characteristics of coated polyglactin 910 suture with triclosan and traditional coated polyglactin 910 in 147 pediatric patients undergoing various general surgical procedures. The study found that there was no significant difference in wound healing parameters between the sutures, except for pain. The authors speculate that by inhibiting bacterial colonization of the suture, the polyglactin 910 suture with triclosan reduced pain that can be an indicator of inflammation or "subclinical" infection and may be a useful alternative to traditional coated polyglactin 910 suture, particularly in patients who are at increased risk of developing an SSI.

Research Studies Utilizing Antimicrobial Sutures

New Anti-infective Coatings of Surgical Sutures Based on a Combination of Antiseptics and Fatty Acids

Matl FD, Zlotnyk J, Obermeier A, Friess W, Vogt S, Büchner H, Schnabelrauch H, Stemberger A, Kühn K-D

A study aims to develop new anti-infective coatings of surgical sutures and compare the anti-microbial effectiveness for avoiding post-operative wound infection and biocompatibility to those of Vicryl Plus®. The study concluded that the development of anti-infective suture coatings consisting of lipid-based drug-delivery systems combined with antiseptics is highly effective against in vitro colonization of bacteria, but drug doses must be adjusted to improve biocompatibility.

In Vivo and in Vitro Antibacterial Efficacy of PDS Plus (Polidioxanone with Triclosan) Suture

Ming X, Rothenburger S, Nichols MM

A study on the efficacy of polydioxanone suture with and without triclosan against gram-positive and gram-negative bacteria was conducted in vitro by zone of inhibition assays and in vivo on guinea pigs and mice. In vitro, polydioxanone suture with triclosan had activity against S. aureus, MRSA, E. coli, S. epidermidis, MRSE, and K. pneumoniae. In vivo, triclosan inhibited colonization of the suture by S. aureus and E. coli. The study concluded that polydioxanone suture with triclosan may be useful in risk reduction of surgical site infection caused by susceptible bacteria.

Prevention of surgical infection using reabsorbable antibacterial suture (Vicryl Plus) versus reabsorbable conventional suture in hernioplasty. An experimental study in animals

Suárez Grau JM, de Toro Crespo M, Docobo Durántez F, Rubio Chaves C, Martín Cartes JA, Docobo Pérez F

An experimental study compared infections provoked in prosthetetic implants fixed with reabsorbable conventional sutures with those in meshes fixed with reabsorbable sutures with antiseptic impregnation during hernioplasty in 20 rats. The study concluded that use of the new antimicrobial suture (Vicryl Plus) by mesh fixation can reduce the rate of surgical site infection.

In Vivo Antibacterial Efficacy of MONOCRYL Plus Antibacterial Suture (Poliglecaprone 25 with Triclosan)

Ming X, Nichols M, Rothenburger S

An in vivo study on the ability of poliglecaprone 25 suture with triclosan to inhibit bacterial colonization in 10 mouse and 10 guinea pig models concluded that poliglecaprone 25 suture with triclosan produced a more than two-log reduction in colonized bacteria compared with conventional poliglecaprone 25 suture after direct in vivo challenge with S. aureus and E. coli, two prevalent organisms associated with surgical site infection.

In Vitro Antibacterial Efficacy of MONOCRYL Plus Antibacterial Suture (Poliglecaprone 25 with Triclosan)

Ming X, Rothenburger S, Yang D

An in vitro study on the efficacy of poliglecaprone 25 suture with triclosan against gram-positive and gram-negative bacteria concluded that, in comparison to untreated suture material, it provided sustained and stable in vitro antibacterial efficacy sufficient to inhibit or reduce in vitro colonization of the suture by S. aureus, MRSA, S. epidermidis, MRSE, E. coli and K. pneumoniae.

Study of the efficacy of Coated VICRYL Plus® Antibacterial suture (coated Polyglactin 910 suture with Triclosan) in two animal models of general surgery

Gómez-Alonso A, García-Criado FJ, Parreño-Manchado FC, García-Sánchez JE, García-Sánchez E, Parreño-Manchado A, Zambrano-Cuadrado Y

A prospective, open, comparative, in vitro and in vivo study including 20 minipigs evaluated the efficacy of Coated VICRYL plus Antibacterial suture (PGAB) and its impact on wound healing compared with traditonal braided suture (PG). The study concluded that PGAB prevents colonization of bacteria and modulates the inflammatory response, which allows tissue healing even in wounds that are infected. The results seem to warrant the use of PGAB as a prophylaxis against surgical infection.

Bacterial Adherence to Surgical Sutures: Can Antibacterial-Coated Sutures Reduce the Risk of Microbial Contamination?

Edmiston CE, Seabrook GR, Goheen MP, Krepel CJ, Johnson CP, Lewis BD, Brown KR, Towne JB

An in vitro study assessing bacterial adherence and antibacterial activity of a triclosan-coated polyglactin 910 (braided) suture against selected Gram-positive and Gram-negative clinical isolates found substantial reductions in both Gram-positive and Gram-negative bacterial adherence on triclosan-coated sutures compared with noncoated material. The study concluded that treating the suture with triclosan provides an effective strategy to reduce perioperative surgical morbidity because bacterial contamination of suture material in a surgical wound may increase the virulence of a surgical site infection.

Impact of Triclosan-Impregnated Suture on in vitro Adherence of Nosocomial Surgical Pathogens

Edmiston C, Schmitt A, Krepel C, Seabrook G

An in vitro study evaluating the effectiveness of triclosan-impregnated vicryl suture to prevent microbial adherence found that they are effective at preventing microbial adherence of selected nosocomial pathogens and by extension may reduce the risk of superficial incisional site infection in at-risk surgical populations. Additional studies are needed to validate the antimicrobial and clinical efficacy of this device in surgical patients.

In Vitro Antimicrobial Evaluation of Coated VICRYL* Plus Antibacterial Suture (Coated Polyglactin 910 with Triclosan) using Zone of Inhibition Assays

Rothenburger S, Spangler D, Bhende S, Burkley D

An in vitro study evaluating coated polyglactin 910 suture with triclosan for its ability to inhibit the growth of S. aureus, MRSA and S. epidermidis found data to support the conclusion that coated polyglactin 910 suture with triclosan provides an antimicrobial effect sufficient to prevent in vitro colonization of the suture by S. aureus and S. epidermidis.