Antibiotic implants reduce surgical site infections

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1. Gentamicin-collagen implants significantly reduced the incidence of surgical site infections (SSIs) with a calculated number needed to treat (NNT) of 21 patients. 

2. Clean, clean-contaminated and sternal wounds treated with gentamicin-collagen implants were associated with a significant decrease in SSIs. 

Evidence Rating Level: 1 (Excellent) 

Study Rundown: SSIs are a common post-surgical complication resulting in increased morbidity and mortality. This study conducted a meta-analysis of fifteen randomized control trials that assessed the effectiveness of gentamicin-collagen implants at reducing the rate of SSIs. Overall, the rate of SSIs was significantly decreased by gentamicin-collagen prophylaxis and was shown to be a cost-effective intervention. Although a well-designed and conducted meta-analysis, this study was limited by constituent RCT heterogeneity. Eight of the fifteen included RCTs where single-center trials and one of the large multi-center trials demonstrated an increased rate of SSI after gentamicin-collagen implantation after colorectal surgery. The majority of patients included in the analysis underwent cardiothoracic surgery, which likely accounts for the specific lower rate of SSI in sternal wounds and possibly introduced unknown confounders. Additionally, as no placebo implant was used, it is unclear whether antibiotic therapy or collagen scaffold provides the greatest benefit in terms of SSI prevention.

Click to read the study in Annals of Surgery

Relevant Reading: CDC information on Surgical Site Infections

In-Depth [systematic review]: This study analyzed fifteen RCTs and over six thousand patients randomized to receive either gentamicin-collagen implants or standard of care treatment. Studies were independently located by two authors using specific search terms and the Cochrane Highly Sensitive Search Strategy. The Jadad scoring system and Cochrane Collaboration tool were used for assessing study quality and possible bias. SSI rates associated with gentamicin-collagen use were decreased for clean (OR=0.53, NNT=30) and clean-contaminated (OR = 0.43, NNT=9) surgeries, while contaminated or dirty surgeries did not demonstrate a concomitant SSI rate decrease. Additionally, gentamicin-collagen implants were associated with a significant drop in sternal incision infections (OR =0.59, NNT=32).

By Asya Ofshteyn and Allen Ho

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