Effect of Different Local Antibiotic Regimens on Prevention of Postoperative Infection in Clean Surgical Wounds: A Systematic Review and Network Meta-analysis.
Hai Bang Pan, Yan Cui, Zhi Hang Wu and 6 others
PMID 38353666WHAT IT FOUND
In clean surgical wounds, some topical antibiotics were associated with fewer infections than control, including gentamicin ointment, mupirocin ointment, and gentamicin-soaked graft.
Vancomycin-soaked graft ranked highest, but bias and publication concerns remain.
Key findings
01In 20 randomized trials with 9,974 participants, gentamicin ointment, mupirocin ointment, and gentamicin-soaked graft significantly reduced surgical site infection compared with control.
02The analysis ranked vancomycin-soaked graft first (86.7% probability of being best), followed by gentamicin ointment (81.1%); control was last (15.3%).
03The findings apply to clean surgical wounds; the authors note nonclean surgery, especially gastrointestinal surgery, may not show the same effect.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The included trials covered different surgical procedures, local antibiotic types, and patient ages, so the findings may not transfer equally to every wound care setting. Blinding was a major risk of bias, and some surgeons could not be blinded during the procedure. The funnel plot showed asymmetry, so publication bias may have affected the pooled results. The inconsistency test was significant, and the analysis used an inconsistent model rather than a consistent model. The results apply only to clean surgical wounds; nonclean surgery may not show the same benefit. Local antibiotic doses and pharmacokinetics varied, and the paper says dosing often depends on surgeon experience rather than established data.
Declared interests
The authors disclosed no financial relationships.
The easy way to misread this
Do not read the positive pooled results as approval to add topical antibiotics to every surgical wound. The review applies to clean surgery, several comparisons were indirect, publication bias was possible, and the paper notes CDC guidance does not recommend topical antimicrobials at incisions for surgical site infection prevention.