Triklosanbelagte suturer til forebygging av infeksjoner i operasjonsområde: en fullstendig metodevurdering

We have summarized the efficacy and safety and assessed the health economic consequences of the use of triclosan-coated sutures compared to standard sutures for the prevention of surgical site infections. Triclosan is an antimicrobial agent associated with antibiotic resistance and environmental pollution. Therefore, we have also evaluated the potential impact of triclosancoated sutures on antibiotic resistance and the environment. The certainty to the estimates of effect were assessed using the GRADE tool (high, moderate, low, or very low). In the meta-analyses of the studies with low and moderate risk of bias, we found that the use of triclosan-coated sutures compared to standard sutures resulted in: • no difference or possibly a small reduction in the risk of infections after gastrointestinal/abdominal surgeries. (GRADE: low). • little or no difference after cardiovascular surgeries. (GRADE: low) • uncertain results for orthopaedic surgeries, and both fewer and more infections may occur. The confidence interval was wide. (GRADE: very low). • no difference or possibly a small reduction in the risk of infections after clean (non-infected) surgeries. Cardiovascular and orthopaedic surgeries are classified as clean. (GRADE: low) For subgroup analyses of superficial infections, studies with low risk of bias, and studies with participant numbers over 1000, the confidence intervals crossed the line of no effect. We assessed the certainty of the evidence as moderate for studies with low risk of bias and low in the others. In these analyses, we did not differentiate between different surgical procedures. In the health economic assessment, subgroup analyses within gastrointestinal and abdominal surgeries of laparoscopic colon surgery, open colon surgery, and laparoscopic gallbladder removal suggested that triclosan-coated sutures may provide both cost savings and additional costs. The results for all three analyses indicated a tendency that the use of triclosan-coated sutures potentially would lead to less cost savings the lower the infection incidence. Triclosan can be linked to antibiotic resistance in several important pathogenic bacteria as well as environmental bacteria, and it can lead to increased transfer of antibiotic resistance genes between bacteria. One question is whether any benefit from the use of triclosan outweighs the risk of developing antibiotic resistance. The amounts of triclosan expected to be released into the environment after use in sutures are low. Although the emission is undesirable, the impact on the environment is likely to be minimal. If the use of triclosan-coated sutures is a valuable, environmental considerations will probably not be an obstacle to their use. If new studies are to be conducted, our experts from the field have proposed studies with a cluster-randomized design where infections after caesarean sections, gallbladder surgeries, and colon surgeries are registered.