Control strategies to prevent total hip replacement-related infections: a systematic review and mixed treatment comparison

Zhang, Henry, Barnett, Adrian G., Merollini, Katharina, Sutton, Alex, Cooper, Nicola, Berendt, Tony, Wilson, Jennie ORCID: 0000-0002-4713-9662 and Graves, Nicholas (2014) Control strategies to prevent total hip replacement-related infections: a systematic review and mixed treatment comparison. BMJ Open, 4. e003978. ISSN 2044-6055

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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 doubleblind randomised controlled trials to better inform the current clinical guidelines and practice for prevention of THR-related SSIs.

Item Type: Article
Additional Information: This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
Subjects: Medicine and health
Medicine and health > Nursing
Depositing User: Jennie Wilson
Date Deposited: 31 May 2016 11:56
Last Modified: 10 Nov 2017 16:32
URI: http://repository.uwl.ac.uk/id/eprint/2277

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