Help protect your patients with Plus Antibacterial Sutures

Meta-analysis demonstrates 28% reduction in surgical site infection (SSI) risk with the use of triclosan-coated sutures1*†

*In a meta-analysis that included 21 RCTs, 6462 patients, 95% CI: (14, 40%), P<0.001.†All triclosan-coated sutures in these RCTs were Ethicon Plus Antibacterial Sutures (MONOCRYL Plus Suture, VICRYL Plus Suture, and PDS Plus Suture).

Three globally recognized health authorities now recommend the use of triclosan-coated sutures for SSI prevention

†CDC, WHO, and ACS/SIS guidelines on reducing the risk of surgical site infections are general to triclosan-coated sutures and are not specific to any one brand.

Centers for DiseaseControl and Prevention(CDC)

World Health Organization (WHO) American College of Surgeons& Surgical Infection Society

Consider the use of triclosan-coated suturesfor the prevention of SSI.9†

The panel suggests the use oftriclosan-coated sutures for the purpose of reducing the risk of SSI, independent of the type of surgery.10†

Triclosan antibacterial suture useis recommended for wound closurein clean and clean-contaminatedabdominal cases when available.11†

Ethicon Plus Sutures are the only sutures with triclosan available worldwide

Traditionalsuture

Plus Antibacterial

Suture

Sutures—like all implanted materials—can be a nidus for infection, because they lower the infective threshold; ie, they decrease the amount of bacteria needed to cause an SSI.1 In fact, 67% of all SSIs are confined to the incision.2,3

Plus Antibacterial Sutures have been shown in vitro to inhibit bacterial colonization of the suture for 7 days or more, for protection against the most common organisms associated with SSI.4-8

The petri dish image is for illustrative purposes only, zone of inhibition testing results can vary.

*PDS Plus Suture andMONOCRYL Plus Suture only

Staphylococcus aureus

Staphylococcus epidermidis

Methicillin-resistantStaphylococcus aureus(MRSA)

Methicillin-resistantStaphylococcus epidermidis(MRSE)

Escherichia coli*

Klebsiella pneumoniae*

You can’t tell the di�erence, but bacteria canPlus Sutures are the only intervention to address a well-known SSI risk factor: bacterial colonization of the suture

non- antibacterial suture

Plus Antibacterial Suture

For illustrative purposes only

Prospectively planned meta-analysesof RCTs performed on the use of suturecontaining triclosan to lower SSI rates

META-ANALYSES OVERVIEW

RCTspatients

X

3,720

17

Wang2013

1,631

7

Sajid2013

836

7

Chang2012

3,568

13

Edmiston2013

5,256

13

Guo2016

2,168

6

Sandini2016

5,346

13

Wu2016

5,985

16

Daoud2014 (updated)

6,930

21

Apisarnthanarak2015

OR=0.77 (23%) OR=0.61 (39%) RR=0.734 (27%) RR=0.70 (30%) RR=0.71 (29%) RR=0.74 (26%) RR=0.76 (24%) RR=0.72 (28%) RR=0.81 (19%) OR=0.61 (39%) RR=0.72 (28%)

P=0.45 P=0.04 P<0.005 P<0.001 P<0.0012 P=0.12 P<0.001 P=0.001 P=0.220 P<0.001P<0.001(CI=0.52-0.73)

RES

ULT

S

6,462

21

de Jonge2017

N/A

20

Leaper2016

Determining the ability of triclosan-coated sutures to help reduce the risk of SSI is the subject of 11 meta-analyses of 28 randomized controlled trials (RCTs) involving over 7,000 patients1,12-22

Ethicon Plus Antibacterial Sutures are supportedby level 1A clinical evidence12

Meta-analysis demonstrates 28% reduction in SSI risk with the use of triclosan-coated sutures1*†

• 21 RCTs, 6462 patients, 95% CI: (14, 40%), P<0.001

• All triclosan-coated sutures in these RCTs were Ethicon Plus Antibacterial Sutures

Meta-regression analyses demonstrated that the e�ect of triclosan-coated sutures in reducing the risk of SSI does not vary by CDC wound classification‡ or suture type1*

*21 RCTs, 6462 patients, 95% CI: (14, 40%), P<0.001 †All triclosan-coated sutures in these RCTs were Ethicon Plus Antibacterial Sutures (MONOCRYL Plus Suture, VICRYL Plus Suture, and PDS Plus Suture)‡Clean wounds 10 RCT, 2842 patients, 95% CI (11-43%), P=0.003; non-clean wounds 14 RCT, 3,620 patients, 95% CI (7–42%).

©2019 Ethicon US, LLC. All rights reserved. 105437-190114

Plus Sutures are available in barbed and non-barbed designs and handle and performjust like non-antibacterial sutures23

For complete indications, contraindications,

warnings, precautions, and adverse reactions,

please reference full package insert.

References: 1. de Jonge SW, Atema JJ, Solomkin JS, Boermeester MA. Meta-analysis and trial sequential analysis of triclosan-coated sutures for the prevention of surgical-site infection. Br J Surg. 2017;104(2):e118-e133. 2. Mangram J, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999;27(2):97-132. 3. WHO Guidelines for Safe Surgery 2009: Safe Surgery Saves Lives. Geneva: World Health Organization; 2009. 4. Rothenburger S, Spangler D, Bhende S, Burkley D. In vitro antimicrobial evaluation of Coated VICRYL* Plus Antibacterial Suture (coated polyglactin 910 with triclosan) using zone of inhibition assays. Surg Infect (Larchmt). 2002;3 Suppl 1:S79-S87. 5. Ming X, Rothenburger S, Nichols MM. In vivo and in vitro antibacterial e�icacy of PDS plus (polidioxanone with triclosan) suture. Surg Infect (Larchmt). 2008;9(4):451-457. 6. Ming X, Rothenburger S, Yang D. In vitro antibacterial e�icacy of MONOCRYL plus antibacterial suture (Poliglecaprone 25 with triclosan). Surg Infect (Larchmt). 2007;8(2):201-208. 7. Edmiston CE, Seabrook GR, Goheen et al. Bacterial adherence to surgical sutures: Can antibacterial-coated sutures reduce the risk of microbial contamination? J Am Coll Surg. 2006;203:481-489. 8. Storch ML, Rothenburger SJ, Jacinto G. Experimental e�icacy study of coated VICRYL plus antibacterial suture in guinea pigs challenged with Staphylococcus aureus. Surg Infect (Larchmt). 2004;5(3):281-288. 9. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection. 2017. JAMA Surg. 2017;153(8):784-791. 10. WHO Global Guidelines for the Prevention of Surgical Site Infection, 2016. 11. Ban KA, Minei JP, Laronga C, et al. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg. 2016;224(1):59-74. 12. Leaper DJ, Edmiston CE Jr, Holy CE. Meta-analysis of the potential economic impact following introduction of absorbable antimicrobial sutures. Br J Surg. 2017;104(2):e134-e144. 13. Apisarnthanarak A, Singh N, Bandong AN, et al. Triclosan-coated sutures reduce the risk of surgical site infections: a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2015;36:169-179. 14. Chang WK, Srinivasa S, Morton R, et al. Triclosan-impregnated sutures to decrease. Surgical Site Infections: Systematic Review and Meta-Analy-sis of Randomized Trials. Ann Surg. 2012;255(5):854-859. 15. Daoud FC, Edmiston CE Jr, Leaper D. Meta-analysis of prevention of surgical site infections following incision closure with triclosan-coated sutures: robustness to new evidence. Surg Infect (Larchmt). 2014;15(3):165-181. 16. Daoud FC. Systematic literature review update of the PROUD Trial: potential usefulness of a collaborative database. Surg Infect (Larchmt). 2014;15(6):857-858. 17. Edmiston CE, Daoud FC,Leaper D. 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. Surgery. 2013;154(1):89-100. 18. Guo J, Pan LH, Li YX, et al. E�icacy of triclosan-coated sutures for reducing risk of surgical site infection in adults: a meta-analysis of randomized clinical trials. J Surg Res. 2016; 201(1):105-117. 19. Sajid MS, Craciunas L, Sains P, et al. Use of antibacterial sutures for skin closure in controlling surgical site infections: a systematic review of published randomized, controlled trials. Gastroenterol Rep (Oxf). 2013;1(1):42-50. 20. Sandini M, Mattavelli I, Nespoli L, Uggeri F, Gianotti L. Systematic review and meta-analysis of sutures coated with triclosan for the prevention of surgical site infection after elective colorectal surgery according to the PRISMA statement. Medicine (Baltimore). 2016;95(35):e4057. 21. Wang ZX, Jiang CP, Cao Y, et al. Systematic review and meta-analysis of triclosan-coated sutures for the prevention of surgical-site infection. Brit J Surg. 2013;100(4): 465-473. 22. Wu X, Kubilay NZ, Ren J, et al. Antimicrobial-coated sutures to decrease surgical site infections: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis. 2017;36(1):19-32. 23. Ford HR, Jones P, Gaines B, Reblock K, Simpkins DL. 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). Surg Infect (Larchmt). 2005;6(3):313-¬321.