Efficacy of different preoperative skin antiseptics on the incidence of surgical site infections: a systematic review, GRADE assessment, and network meta-analysis

Jalalzadeh, Hasti; Groenen, Hannah; Buis, Dennis R.; Dreissen, Yasmine EM; Goosen, Jon HM; Ijpma, Frank FA; Laan, Maarten J. van der; Schaad, Roald R; Segers, Patrique; Zwet, W.C. van der; Griekspoor, Mitchel; Harmsen, Wouter J; Wolfhagen, Niels; Boermeester, Marja A.

doi:10.1016/s2666-5247(22)00187-2

Cited by 22 publications

(12 citation statements)

References 63 publications

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“…Meta-analyses by Norman et al 45 and Zwanenburg et al 46 both demonstrated a lower rate of SSI with negative-pressure wound therapy compared with standard dressings. There are also “biofilm busters” with peer-reviewed data, including HOCL (pure hypochlorous acid, pH 5.5), 47 and the joint rinse experience including chlorhexidine, iodine, and olanexidine 48 . Nonantibiotic therapy provides a new option for the prevention of wound infection and, when combined with topical antibiotics, may help reduce the selection pressure on microorganisms and thus reduce antibiotic resistance.…”

Section: Discussionmentioning

confidence: 99%

Effect of Different Local Antibiotic Regimens on Prevention of Postoperative Infection in Clean Surgical Wounds: A Systematic Review and Network Meta-analysis

Pan,

Cui,

et al. 2024

Adv Skin Wound Care

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OBJECTIVE To compare the efficacy of several local antibiotic regimens in preventing surgical site infection (SSI) in clean surgical wounds. DATA SOURCES The authors searched CNKI (China National Knowledge Infrastructure), the VIP (VIP information resource integration service platform), Wanfang Data knowledge service platform (WANFANG), SinoMed, Cochrane Library, EMBASE, and PubMed. STUDY SELECTION A total of 20 randomized controlled trials published between January 1, 2000 and April 1, 2021 were included in this meta-analysis. DATA EXTRACTION Authors extracted the name of the first author, publication date, country, type of surgery, follow-up time, mean age of participants, sample size of each group, interventions, outcome indicators, and study type from each article. DATA SYNTHESIS The overall effectiveness of eight local managements in reducing the incidence of the SSI effect were compared through the SUCRA (surface under the cumulative ranking curve) probabilities. The results of a network meta-analysis demonstrated that gentamicin ointment (odds ratio [OR], 0.16; 95% CI, 0.04–0.60), mupirocin ointment (OR, 0.44; 95% CI, 0.21–0.94), and gentamicin soaking of the graft (OR, 0.63; 95% CI, 0.44–0.91) significantly reduced the incidence of SSI compared with control. Further, vancomycin soaking of the graft (86.7%) ranked first, followed by gentamicin ointment (81.1%), gentamicin irrigation (79.9%), mupirocin ointment (56.8%), triple antibiotic ointment (47.8%), gentamicin soaking of the graft (42.3%), and vancomycin powder (22.1%); ampicillin powder (17.8%) was the least effective drug. CONCLUSIONS The findings indicate that local antibiotics combined with conventional antibiotics in the wound before wound closure are effective in reducing the incidence of SSI in clean surgical wounds. Vancomycin inoculation of the graft exhibited the best effect.

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Section: Discussionmentioning

confidence: 99%

Effect of Different Local Antibiotic Regimens on Prevention of Postoperative Infection in Clean Surgical Wounds: A Systematic Review and Network Meta-analysis

Pan,

Cui,

et al. 2024

Adv Skin Wound Care

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“…Among the RCTs that investigated antiseptics for pIOWI, the majority focused on iodine solutions. However, a recent network meta-analysis on skin antiseptics found the use of chlorhexidine in alcohol to be associated with a reduction in SSI compared with iodine in alcohol . In line with these findings, using aqueous chlorhexidine for prophylactic wound irrigation may be more effective than aqueous iodine in reducing SSI.…”

Section: Discussionmentioning

confidence: 99%

Incisional Wound Irrigation for the Prevention of Surgical Site Infection

Groenen,

Bontekoning,

Jalalzadeh

et al. 2024

JAMA Surg

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ImportanceSurgical site infections (SSIs) are common postoperative complications and associated with significant morbidity, mortality, and costs. Prophylactic intraoperative incisional wound irrigation is used to reduce the risk of SSIs, and there is great variation in the type of irrigation solutions and their use.ObjectiveTo compare the outcomes of different types of incisional prophylactic intraoperative incisional wound irrigation for the prevention of SSIs in all types of surgery.Data SourcesPubMed, Embase, CENTRAL, and CINAHL databases were searched up to June 12, 2023.Study SelectionIncluded in this study were randomized clinical trials (RCTs) comparing incisional prophylactic intraoperative incisional wound irrigation with no irrigation or comparing irrigation using different types of solutions, with SSI as a reported outcome. Studies investigating intracavity lavage were excluded.Data Extraction and SynthesisThis systematic review and network meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Two reviewers independently extracted the data and assessed the risk of bias within individual RCTs using the Cochrane Risk of Bias 2 tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A frequentist network meta-analysis was conducted, and relative risks (RRs) with corresponding 95% CIs were reported.Main Outcome and MeasureThe primary study outcome was SSI.ResultsA total of 1587 articles were identified, of which 41 RCTs were included in the systematic review, with 17 188 patients reporting 1328 SSIs, resulting in an overall incidence of 7.7%. Compared with no irrigation, antiseptic solutions (RR, 0.60; 95% CI, 0.44-0.81; high level of certainty) and antibiotic solutions (RR, 0.46; 95% CI, 0.29-0.73; low level of certainty) were associated with a beneficial reduction in SSIs. Saline irrigation showed no statistically significant difference compared with no irrigation (RR, 0.83; 95% CI, 0.63-1.09; moderate level of certainty).Conclusions and RelevanceThis systematic review and network meta-analysis found high-certainty evidence that prophylactic intraoperative incisional wound irrigation with antiseptic solutions was associated with a reduction in SSIs. It is suggested that the use of antibiotic wound irrigation be avoided due to the inferior certainty of evidence for its outcome and global antimicrobial resistance concerns.

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“…11 In another meta-analysis, 2,326 articles covering 17 735 patients were reviewed, and the incidence of SSI was reported as 12.1%. 12 The economic burden of surgical site infections Surgical site infections are a significant economic burden globally, and with an estimated cost of US$20,785 per patient, they rank as the third most costly infection. 13 Surgical site infections are the most common HAI in low-and middle-income countries, affecting one-third of surgical patients.…”

Section: Introductionmentioning

confidence: 99%

Surgical Site Infections: Prevalence, Economic Burden, and New Preventive Recommendations

Maraş¹,

Sürme²

2023

Explor Res Hypothesis Med

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Surgical site infections are the most common and significant epidemiological burden worldwide. Despite implementing modern surgical techniques, appropriate antibiotic prophylaxis, sterilization techniques, and aseptic and antiseptic practices, surgical site infections continue to pose a significant challenge. As a result, patients who experience these infections may require increased antibiotic use, extended hospital stays, and higher treatment costs. This is particularly concerning given that such infections are largely preventable. The financial and social burden imposed by the costs of surgical site infections remains a significant problem for many countries. Evidence-based preventive practices should be integrated into the preoperative, intraoperative, and postoperative periods to prevent these infections. It is estimated that approximately half of all surgical site infections can be prevented by applying evidence-based practices.

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Efficacy of different preoperative skin antiseptics on the incidence of surgical site infections: a systematic review, GRADE assessment, and network meta-analysis

Cited by 22 publications

References 63 publications

Effect of Different Local Antibiotic Regimens on Prevention of Postoperative Infection in Clean Surgical Wounds: A Systematic Review and Network Meta-analysis

Effect of Different Local Antibiotic Regimens on Prevention of Postoperative Infection in Clean Surgical Wounds: A Systematic Review and Network Meta-analysis

Incisional Wound Irrigation for the Prevention of Surgical Site Infection

Surgical Site Infections: Prevalence, Economic Burden, and New Preventive Recommendations

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