J Hosp Infect. 2024 May 31:S0195-6701(24)00193-2. doi: 10.1016/j.jhin.2024.04.028. Online ahead of print.
ABSTRACT
BACKGROUND: Evidence were mixed regarding the effect of topical vancomycin (VCM) powder in reducing surgical site infection (SSI).
AIM: To clarify the effect of topical VCM powder for the prevention of in major orthopaedic surgeries.
METHODS: The MEDLINE, Embase, CENTRAL, ICTRP, and ClinicalTrials.gov databases were searched from their inception to 25 September 2023. We included randomised controlled trials comparing topical VCM powder and controls for the prevention of SSI in major orthopaedic surgeries. Two reviewers independently screened the title and abstract and extracted relevant data, followed by the assessment of the risk of bias and the certainty of the evidence. Main outcome measure were Overall SSI, reoperation, and adverse events. Summary results were obtained using random-effects meta-analysis. We performed trial sequential analysis (TSA).
FINDINGS: Eight randomised controlled trials provided data on 4,307 participants. VCM powder showed no difference in reducing overall SSI. The cumulative number of patients did not exceed the required information size of 19,233 in our TSA, and the Z-curves did not cross the trial sequential monitoring or futility boundary, suggesting an inconclusive result of the meta-analysis. No difference was found for reoperation. Among SSI, VCM powder showed statistically significant difference in reducing gram-positive cocci SSI. However, the certainty of this evidence was very low.
CONCLUSIONS: This systematic review and meta-analysis suggests inconclusive results regarding the effect of VCM powder in reducing SSI in major orthopaedic surgeries. Further trials using rigorous methodologies are required to elucidate the effect of this intervention.
PMID:38825190 | DOI:10.1016/j.jhin.2024.04.028
