Abstract:
OBJECTIVE:To synthesise the available evidence and estimate the comparative efficacy of control strategies to prevent total hip replacement (THR)-related surgical site infections (SSIs) using a mixed treatment comparison. DESIGN:Systematic review and mixed treatment comparison. SETTING:Hospital and other healthcare settings. PARTICIPANTS:Patients undergoing THR. PRIMARY AND SECONDARY OUTCOME MEASURES:The number of THR-related SSIs occurring following the surgical operation. RESULTS:12 studies involving 123 788 THRs and 9 infection control strategies were identified. The strategy of 'systemic antibiotics+antibiotic-impregnated cement+conventional ventilation' significantly reduced the risk of THR-related SSI compared with the referent strategy (no systemic antibiotics+plain cement+conventional ventilation), OR 0.13 (95% credible interval (CrI) 0.03-0.35), and had the highest probability (47-64%) and highest median rank of being the most effective strategy. There was some evidence to suggest that 'systemic antibiotics+antibiotic-impregnated cement+laminar airflow' could potentially increase infection risk compared with 'systemic antibiotics+antibiotic-impregnated cement+conventional ventilation', 1.96 (95% CrI 0.52-5.37). There was no high-quality evidence that antibiotic-impregnated cement without systemic antibiotic prophylaxis was effective in reducing infection compared with plain cement with systemic antibiotics, 1.28 (95% CrI 0.38-3.38). CONCLUSIONS:We found no convincing evidence in favour of the use of laminar airflow over conventional ventilation for prevention of THR-related SSIs, yet laminar airflow is costly and widely used. Antibiotic-impregnated cement without systemic antibiotics may not be effective in reducing THR-related SSIs. The combination with the highest confidence for reducing SSIs was 'systemic antibiotics+antibiotic-impregnated cement+conventional ventilation'. Our evidence synthesis underscores the need to review current guidelines based on the available evidence, and to conduct further high-quality double-blind randomised controlled trials to better inform the current clinical guidelines and practice for prevention of THR-related SSIs.
journal_name
BMJ Openjournal_title
BMJ openauthors
Zheng H,Barnett AG,Merollini K,Sutton A,Cooper N,Berendt T,Wilson J,Graves Ndoi
10.1136/bmjopen-2013-003978subject
Has Abstractpub_date
2014-03-06 00:00:00pages
e003978issue
3issn
2044-6055pii
bmjopen-2013-003978journal_volume
4pub_type
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