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

Abstract

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, I2 = 48 per cent); and RR 2.79, 95 per cent c.i. 0.51 to 15.19 (P = 0.24, I2 = 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, I2 = 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, I2 = 0 per cent), orthopaedic (RR 0.69, 95 per cent c.i. 0.37 to 1.29; P = 0.25, I2 = 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.

Effect of topical antibiotics on the prevention and management of wound infections: A meta‐analysis

“…Further examination is still necessary to illuminate these possible impacts 29–35 . This was similarly emphasised in former research that utilised a connected meta‐analysis practice and originated comparable values of the impact 36–40 . However, the meta‐analysis was unable to determine if differences in these variables are connected to the research results, properly led RCTs must take these factors into account in addition to the variety of diverse ages, genders and ethnicities of people 41–44 .…”

“…[29][30][31][32][33][34][35] This was similarly emphasised in former research that utilised a connected meta-analysis practice and originated comparable values of the impact. [36][37][38][39][40] However, the meta-analysis was unable to determine if differences in these variables are connected to the research results, properly led RCTs must take these factors into account in addition to the variety of diverse ages, genders and ethnicities of people. [41][42][43][44] In conclusion, TAs had significantly lower WI compared with placebo and antiseptics in people with UWs.…”

Surgical Antibiotic Prophylaxis: A Proposal for a Global Evidence-Based Bundle

“…This can decrease its efficacy against this pathogen often isolated in SSIs [53]. Clindamycin has also been reported to be associated with a nearly three-fold increased risk of CDI compared to other antibiotics [54]. Even single doses of clindamycin used for SAP have been associated with an increased risk of CDI.…”

State of the Evidence for Facial Skin Cancer Reconstruction

“…[31][32][33][34][35][36][37] This finding is supported by two meta-analyses that show no statistically significant difference in incidence of postsurgical wound infections between topical antibiotics and petrolatum/paraffin. 38,39 In addition, these studies have shown an increased risk of dermatitis with topical antimicrobials. Neomycin is the most common cause of allergic contact dermatitis (11%), followed by bacitracin (8%).…”