Topical antibiotic prophylaxis for surgical wound infections in clean and clean-contaminated surgery: a systematic review and meta-analysis

doi:10.1093/bjsopen/zrab125

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Title:	Topical antibiotic prophylaxis for surgical wound infections in clean and clean-contaminated surgery: a systematic review and meta-analysis
Authors:	Chen, Po-Jung Hua, Yi-Ming Toh, Han Siong Lee, Mei-Chuan
Contributors:	Chi Mei Med Ctr, Dept Emergency Med Chi Mei Med Ctr, Dept Pharm Chi Mei Med Ctr, Dept Intens Care Med Natl Cheng Kung Univ, Coll Med, Inst Clin Med Chia Nan Univ Pharm & Sci, Dept Hlth & Nutr Natl Cheng Kung Univ, Coll Med, Dept Publ Hlth
Keywords:	SITE INFECTION STAPHYLOCOCCUS-AUREUS NASAL CARRIERS PREVENTION GUIDELINE OINTMENT IMPACT CARRIAGE RATES
Date:	2021
Issue Date:	2023-11-11 11:44:18 (UTC+8)
Publisher:	OXFORD UNIV PRESS
Abstract:	Our results indicate that topical antibiotics did not have a benefit in reducing surgical site infections (SSIs). In addition, topical antibiotics did not result in any reduction in SSIs in different types or different phases of surgery. Background Topical antibiotics are widely prescribed as prophylaxis for surgical site infection (SSI). Despite giving high drug concentrations at local wound sites, their efficacy remains controversial. This study is a systematic review and meta-analysis designed to compare the efficacy and safety of topical antibiotics with non-antibiotic agents in preventing SSI. Methods Randomized controlled trials (RCTs) comparing topical antibiotics in patients with clean and clean-contaminated postsurgical wounds were included. Relevant trials published before 30 September 2020, were searched in the PubMed, Embase, and Cochrane databases, without language restrictions. The primary outcome was the incidence of SSIs, presented as the event rate. The secondary outcome was the incidence of contact dermatitis (safety outcome). Data were synthesized using the random-effects model, with the results expressed as risk ratio (RR) with 95 per cent confidence intervals (c.i.). Results Thirteen RCTs were included. The incidence of SSIs and contact dermatitis showed no significant difference between topical antibiotics and non-antibiotic agents (RR 0.89, 95 per cent c.i. 0.59 to 1.32 (P = 0.56, I-2 = 48 per cent); and RR 2.79, 95 per cent c.i. 0.51 to 15.19 (P = 0.24, I-2 = 0 per cent), respectively). In the subgroup analyses, a reduction in SSIs was also not observed in dermatological (RR 0.77, 95 per cent c.i. 0.39 to 1.55; P = 0.46, I-2 = 65 per cent), ocular (RR 0.08, 95 per cent c.i. 0.00 to 1.52; P = 0.09), spinal (RR 1.34, 95 per cent c.i. 0.65 to 2.77; P = 0.43, I-2 = 0 per cent), orthopaedic (RR 0.69, 95 per cent c.i. 0.37 to 1.29; P = 0.25, I-2 = 0 per cent), or cardiothoracic surgeries (RR 1.60, 95 per cent c.i. 0.79 to 3.25; P = 0.19). Conclusion Given the current evidence, the routine application of topical antibiotics to surgical wounds did not reduce the incidence of SSI. Further trials are needed to assess their effectiveness in high-risk surgeries or in selected patient groups.
Relation:	BJS OPEN, v.5, n.6, zrab125
Appears in Collections:	[Dept. of Health and Nutrition (including master's program)] Periodical Articles

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