Current clinical guidelines vary in their recommendations on the use of coated suture materials in surgical procedures. For example, the German Commission for Hospital Hygiene and Infection Prevention (KRINKO) noted in its 2018 guidelines: “The available evidence is inconsistent. The WHO recommends use regardless of the type of surgery […], whereas the CDC supports its use in visceral surgery.” 1
In light of these differing positions, a meta-analysis was conducted in 2025 to reassess the body of evidence by including more recent studies. The aim was to provide a clearer recommendation on the use of coated suture materials for SSI prevention. 2
A total of 992 publications from the period 2015 to 2023 were identified using predefined search criteria in accordance with PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Of these, 31 randomised clinical trials with a total of 17,968 patients were included in the qualified evaluation. The assessment also considered the strength of evidence based on recognised grading criteria.
The efficacy of triclosan-coated sutures in preventing postoperative wound infections was systematically evaluated. The data showed an SSI incidence of 12.1% in the triclosan group (1,098 out of 8,969 patients) compared to 14.7% in the control group without triclosan (1,324 out of 8,999 patients) 3. This corresponds to 39 fewer wound infections per 1,000 patients treated. The calculated Number Needed to Treat (NNT) was 40 – meaning that 40 patients need to be treated with coated sutures to prevent one infection.
According to the study authors, these findings clearly demonstrate that triclosan-coated suture material significantly reduced the risk of postoperative infections in the included studies. The effect was most pronounced for superficial and deep incisional SSIs, whereas no similarly strong benefit was observed for organ/space infections.
The certainty of the evidence was assessed using GRADE criteria (Grading of Recommendations, Assessment, Development and Evaluation) and was rated as moderate. Despite the high methodological quality of the included studies, this rating was primarily due to some heterogeneity in patient populations, types of surgery, and study designs.
Nonetheless, the authors concluded that the current data provide a robust basis for the statement that triclosan-coated suture material significantly reduces the risk of SSIs. Moreover, they consider it unlikely that future randomised controlled trials will fundamentally alter the current evidence landscape.
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1 Prävention postoperativer Wundinfektionen: Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2018 Apr;61(4):448-473
2 Jalalzadeh H et al.: Triclosan-Containing Sutures for the Prevention of Surgical Site Infection: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2025;8(3):e250306
3 The randomised controlled trials included in the meta-analysis predominantly involved inpatient populations undergoing complex, contamination-prone or visceral surgical procedures, in which the baseline risk of surgical site infections (SSIs) is significantly higher than the average reported across all types of surgical interventions.
