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Gentamicin-Collagen Implants to Reduce Surgical Site Infection: Systematic Review and Meta-analysis of Randomized Trials

Chang, Wai Keat MBChB*; Srinivasa, Sanket MBChB; MacCormick, Andrew D. FRACS; Hill, Andrew G. FRACS

doi: 10.1097/SLA.0b013e3182895b8c
Meta-Analysis

Objective: To determine whether gentamicin-impregnated collagen sponges (gentamicin-collagen implants) decrease the incidence of surgical site infection (SSI).

Background: SSIs cause substantial morbidity and increase the costs of healthcare. Antibiotic prophylaxis is a cornerstone of SSI reduction. Prophylactic local delivery of antibiotics with novel biodegradable drug carrier systems, such as the gentamicin-collagen implant, is a potential avenue for SSI reduction. Gentamicin-collagen implants have been previously assessed in multiple randomized controlled trials (RCTs) with conflicting results. Therefore, a systematic review and meta-analysis of all relevant RCTs was conducted to determine whether gentamicin-collagen implants reduce SSI.

Methods: Major medical databases and trial registers were searched for published and unpublished RCTs. The endpoint of interest was the incidence of SSI. A random effects model was used and pooled estimates were reported as odds ratios (ORs), with the corresponding 95% confidence interval (CI). A subset analysis by incision type was planned a priori.

Results: Fifteen RCTs encompassing a total of 6979 patients were included in the final analysis. The included studies were of moderate to high quality. Gentamicin-collagen implants significantly reduced SSI [OR = 0.51; 95% CI: 0.33–0.77; P = 0.001; number needed to treat (NNT) = 21; I2 = 75%]. These results were seen in subset analysis of clean (OR = 0.53; 95% CI: 0.33–0.87; P = 0.01; NNT = 30) and clean-contaminated surgery (OR = 0.43; 95% CI: 0.20–0.93; P = 0.03; NNT = 9) specifically.

Conclusions: Gentamicin-collagen implants decrease the rate of SSI.

A systematic review and meta-analysis of randomized controlled trials demonstrates that gentamicin-collagen implants decrease the rate of surgical site infection.

*Department of Surgery, Middlemore Hospital, Auckland, New Zealand

Department of Surgery, South Auckland Clinical School, Middlemore Hospital, University of Auckland, Auckland, New Zealand.

Reprints: Wai Keat Chang, MBChB, Department of Surgery, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland, Manukau 1640, New Zealand. E-mail: waikeat@hotmail.co.uk.

Disclosure: The authors declare no conflicts of interest.

© 2013 by Lippincott Williams & Wilkins.