TY - JOUR
T1 - Use of Topical Antibiotics before Primary Incision Closure to Prevent Surgical Site Infection
T2 - A Meta-Analysis
AU - López-Cano, Manuel
AU - Kraft, Miquel
AU - Curell, Anna
AU - Puig-Asensio, Mireia
AU - Balibrea, Jose
AU - Armengol-Carrasco, Manuel
AU - García-Alamino, J. M.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - Background: Surgical site infections (SSIs) remains a concern for surgeons because of the negative impact on outcomes and health care costs. Our purpose was to assess whether topical antibiotics before primary incision closure reduced the rate of SSIs. Methods: Systematic review of MEDLINE/PubMed, Scopus, CINAHL, and Web of Science databases from inception to January 2017. Only randomized controlled trials (RCTs) were retrieved. The primary outcome was the SSI rate. Meta-analysis was complemented with trial sequential analysis (TSA). Results: Thirty-five RCTs (10,870 patients) were included. Only β-lactams and aminoglycosides were used. A substantial reduction of the incidence of SSIs with the application of antibiotic agents before incision closure (risk ratio [RR] 0.49, 95% confidence interval [CI] 0.37-0.64) was found, which remained in the analysis of 12 RCTs after removal of studies of uncertain quality. The use of β-lactams was effective to reduce SSI in elective surgery only (RR 0.33, 95% CI 0.13-0.85). In clean-contaminated fields and as an irrigation solution, β-lactams did not reduce the risk of SSI. Aminoglycosides were not effective (RR 0.74, 95% CI 0.49-1.10). After TSA, the evidence accumulated was far below the optimal information size. The heterogeneity of studies was high and methodological quality of most RCTs included in the meta-analysis was uncertain. Conclusions: Results of this meta-analysis show the data present in the literature are not sufficiently robust and, therefore, the use of topical β-lactams or aminoglycosides before incision closure to reduce SSI cannot be recommended or excluded.
AB - Background: Surgical site infections (SSIs) remains a concern for surgeons because of the negative impact on outcomes and health care costs. Our purpose was to assess whether topical antibiotics before primary incision closure reduced the rate of SSIs. Methods: Systematic review of MEDLINE/PubMed, Scopus, CINAHL, and Web of Science databases from inception to January 2017. Only randomized controlled trials (RCTs) were retrieved. The primary outcome was the SSI rate. Meta-analysis was complemented with trial sequential analysis (TSA). Results: Thirty-five RCTs (10,870 patients) were included. Only β-lactams and aminoglycosides were used. A substantial reduction of the incidence of SSIs with the application of antibiotic agents before incision closure (risk ratio [RR] 0.49, 95% confidence interval [CI] 0.37-0.64) was found, which remained in the analysis of 12 RCTs after removal of studies of uncertain quality. The use of β-lactams was effective to reduce SSI in elective surgery only (RR 0.33, 95% CI 0.13-0.85). In clean-contaminated fields and as an irrigation solution, β-lactams did not reduce the risk of SSI. Aminoglycosides were not effective (RR 0.74, 95% CI 0.49-1.10). After TSA, the evidence accumulated was far below the optimal information size. The heterogeneity of studies was high and methodological quality of most RCTs included in the meta-analysis was uncertain. Conclusions: Results of this meta-analysis show the data present in the literature are not sufficiently robust and, therefore, the use of topical β-lactams or aminoglycosides before incision closure to reduce SSI cannot be recommended or excluded.
KW - antibiotics
KW - closure
KW - infection
KW - prevention
KW - wound
UR - http://www.scopus.com/inward/record.url?scp=85065209129&partnerID=8YFLogxK
U2 - 10.1089/sur.2018.279
DO - 10.1089/sur.2018.279
M3 - Artículo
C2 - 30839242
AN - SCOPUS:85065209129
SN - 1096-2964
VL - 20
SP - 261
EP - 270
JO - Surgical Infections
JF - Surgical Infections
IS - 4
ER -
