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Depth and Procedure Specific Effects of Antimicrobial Versus Conventional Sutures on Surgical Site Infection: A
Ryan Muakkassa1, Andrew Roach1, Ahmed Adham R Elsayed1,2,3
1College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio, USA.
Background:
Surgical site infections (SSIs) are common postoperative complications that delay wound healing and increase morbidity and healthcare costs. Conventional sutures lack antimicrobial properties and may act as a nidus for infection. Antimicrobial-coated sutures have been proposed to reduce SSI rates. This systematic review synthesizes literature comparing traditional and antimicrobial sutures regarding SSIs and wound healing to inform clinical guidelines and future research.
Methods:
A systematic review was conducted according to PRISMA guidelines. PubMed, Cochrane Library, Web of Science, and VHL were searched on March 25, 2025, using terms related to antimicrobial sutures, traditional sutures, and surgical site infection. Two independent reviewers screened studies by title and abstract, followed by full-text review using predefined eligibility criteria. Included studies were original investigations in English involving live human subjects.
Results:
Included studies primarily evaluated absorbable sutures, most commonly polyglactin 910 and polydioxanone, with antimicrobial variants incorporating triclosan or chlorhexidine. Antimicrobial sutures did not significantly reduce superficial SSI (OR 0.92, 95% CI 0.69-1.24, p = 0.59) but were associated with a 36% reduction in deep SSI (OR 0.64, 95% CI 0.44-0.93, p = 0.02). Significant reductions were observed in abdominal (OR 0.61, 95% CI 0.39-0.97, p = 0.04) and colorectal procedures (OR 0.60, 95% CI 0.45-0.80, p = 0.0004), but not in vascular or cardiothoracic surgery. In procedures demonstrating significant benefit, the incremental cost of antimicrobial sutures was lower than the estimated cost of treating SSI.
Conclusion:
Antimicrobial sutures reduce deep, but not superficial, SSIs, with most benefit in abdominal and colorectal procedures. This supports selective, risk-stratified implementation of antimicrobial sutures.
Insights
Antimicrobial sutures effectively reduce deep surgical site infections (SSIs), particularly in abdominal and colorectal surgeries. While not impacting superficial SSIs, their use is cost-effective compared to treating infections.
Area of Science:
- Surgical Innovation
- Infectious Disease Prevention
- Materials Science in Medicine
Background:
- Surgical site infections (SSIs) are a significant cause of postoperative morbidity and increased healthcare costs.
- Conventional sutures can serve as a nidus for infection, lacking inherent antimicrobial properties.
- Antimicrobial sutures offer a potential strategy to mitigate SSI rates.
Purpose of the Study:
- To systematically review and synthesize evidence comparing antimicrobial sutures with traditional sutures for SSI prevention and wound healing.
- To inform clinical practice guidelines and identify areas for future research in surgical infection control.
Main Methods:
- A systematic review adhering to PRISMA guidelines was performed.
- Searches were conducted across major databases (PubMed, Cochrane, Web of Science, VHL) for relevant studies.
- Two independent reviewers screened and assessed study eligibility, including original investigations on human subjects.
Main Results:
- Antimicrobial sutures showed a significant 36% reduction in deep SSIs (OR 0.64) but no significant effect on superficial SSIs.
- Benefit was most pronounced in abdominal (OR 0.61) and colorectal procedures (OR 0.60).
- Cost-effectiveness was demonstrated where benefits were observed, with lower costs than treating SSIs.
Conclusions:
- Antimicrobial sutures are effective in reducing deep SSIs, especially in specific surgical fields like abdominal and colorectal procedures.
- Implementation should be selective and risk-stratified based on procedure type.
- Further research may refine the application of antimicrobial sutures for optimal SSI prevention.
