Depth and Procedure Specific Effects of Antimicrobial Versus Conventional Sutures on Surgical Site Infection: A Systematic Review and Meta‐Analysis

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.