Surgical site infections (SSIs) account for approximately 20% of all compromised wounds in the Canadian healthcare setting. It is estimated that 6.3% of surgical wounds in Canada result in infection. An overall SSI rate of 2.5% was reported in a sample of hospitalized adults across Canada. In addition to increasing the risk of morbidity, delayed recovery, and prolonged hospital stay, SSIs may increase Canadian healthcare costs associated with surgical procedures. It is estimated that the incidence of SSIs could be reduced by over 50% with the implementation of various evidence-based prevention strategies. Risk factors for SSIs include patient related factors (e.g., diabetes, obesity), category of wound (e.g., clean, clean-contaminated), bacterial species, and hospital-related infection prevention measures. Sutures may act as a medium for bacterial growth and it has been demonstrated by in-vitro and in-vivo animal studies that antimicrobial coating may reduce the risk of SSIs. Antimicrobial sutures, which are currently commercially limited to triclosan coated sutures (TCS) (e.g., Vicryl [polyglactin 910] Plus, Monocryl [poliglecaprone 25] Plus, PDS [polydioxanone] Plus), are targeted for the prevention of SSIs. Although antimicrobial sutures are more costly than conventional sutures, if effective for SSI prevention they may reduce surgery related costs. 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.

Contents

• CONTEXT AND POLICY ISSUES
• RESEARCH QUESTIONS
• KEY FINDINGS
• METHODS
  • Literature Search Strategy
  • Selection Criteria and Methods
  • Exclusion Criteria
  • Critical Appraisal of Individual Studies
• SUMMARY OF EVIDENCE
  • Quantity of Research Available
  • Summary of Study Characteristics
  • Summary of Critical Appraisal
  • Summary of Findings
  • Limitations
• CONCLUSIONS AND IMPLICATIONS FOR DECISION OR POLICY MAKING
• REFERENCES
• APPENDIX 1 Selection of Included Studies
• APPENDIX 2 Characteristics of Clinical Studies
• APPENDIX 3 Centers of Disease Control and Prevention Criteria
• APPENDIX 4 Characteristics of Economic Studies
• APPENDIX 5 Critical Appraisal of Clinical Evidence
• APPENDIX 6 Critical Appraisal of Economic Studies
• APPENDIX 7 Summary of Clinical Findings
• APPENDIX 8 Summary of Findings of Economic Studies

Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.