Abstract：
BACKGROUND: Evidence has been mixed regarding the effect of topical vancomycin (VCM) powder in reducing surgical site infection (SSI).
OBJECTIVE: To clarify the effect of topical VCM powder for the prevention of SSI in major orthopaedic surgeries.
METHODS: The MEDLINE, Embase, CENTRAL, ICTRP, and ClinicalTrials.gov databases were searched from their inception to September 25th, 2023. Randomized controlled trials comparing topical VCM powder and controls for the prevention of SSI in major orthopaedic surgeries were included. Two reviewers independently screened the title and abstract and extracted relevant data, followed by the assessment of the risk of bias and the certainty of the evidence. Main outcome measures were overall SSI, reoperation, and adverse events. Summary results were obtained using random-effects meta-analysis. Trial sequential analysis (TSA) was performed.
RESULTS: Eight randomized controlled trials yielded data on 4307 participants. VCM powder showed no difference in reducing overall SSI. The cumulative number of patients did not exceed the required information size of 19,233 in our TSA, and the Z-curves did not cross the trial sequential monitoring or futility boundary, suggesting an inconclusive result of the meta-analysis. No difference was found for reoperation. Among SSIs, VCM powder showed a statistically significant difference in reducing Gram-positive cocci SSI. However, the certainty of this evidence was very low.
CONCLUSIONS: This systematic review and meta-analysis suggests inconclusive results regarding the effect of VCM powder in reducing SSI in major orthopaedic surgeries. Further trials using rigorous methodologies are required to elucidate the effect of this intervention.
OBJECTIVE: To clarify the effect of topical VCM powder for the prevention of SSI in major orthopaedic surgeries.
METHODS: The MEDLINE, Embase, CENTRAL, ICTRP, and ClinicalTrials.gov databases were searched from their inception to September 25th, 2023. Randomized controlled trials comparing topical VCM powder and controls for the prevention of SSI in major orthopaedic surgeries were included. Two reviewers independently screened the title and abstract and extracted relevant data, followed by the assessment of the risk of bias and the certainty of the evidence. Main outcome measures were overall SSI, reoperation, and adverse events. Summary results were obtained using random-effects meta-analysis. Trial sequential analysis (TSA) was performed.
RESULTS: Eight randomized controlled trials yielded data on 4307 participants. VCM powder showed no difference in reducing overall SSI. The cumulative number of patients did not exceed the required information size of 19,233 in our TSA, and the Z-curves did not cross the trial sequential monitoring or futility boundary, suggesting an inconclusive result of the meta-analysis. No difference was found for reoperation. Among SSIs, VCM powder showed a statistically significant difference in reducing Gram-positive cocci SSI. However, the certainty of this evidence was very low.
CONCLUSIONS: This systematic review and meta-analysis suggests inconclusive results regarding the effect of VCM powder in reducing SSI in major orthopaedic surgeries. Further trials using rigorous methodologies are required to elucidate the effect of this intervention.
摘要：
背景：关于万古霉素（VCM）外用粉剂在减少手术部位感染（SSI）方面的作用的证据不一。
目的：阐明外用VCM粉预防骨科大手术的效果。
方法：MEDLINE，Embase,中部,ICTRP,和ClinicalTrials.gov数据库从成立到2023年9月25日进行了搜索。我们纳入了随机对照试验，比较了局部用VCM粉和对照组在大型骨科手术中预防SSI的作用。两名审稿人独立筛选标题和摘要，并提取相关数据，其次是评估偏倚的风险和证据的确定性。主要结果指标是总体SSI，再操作,和不良事件。使用随机效应荟萃分析获得总结结果。我们进行了试验序贯分析(TSA)。
结果：8项随机对照试验提供了4,307名参与者的数据。VCM粉末在降低总体SSI方面没有差异。在我们的TSA中，患者的累积人数未超过所需的19,233信息大小，Z曲线没有越过试验序贯监测或无效边界，这表明荟萃分析的结果不确定。再次手术没有发现差异。在SSI中，VCM粉末在减少革兰氏阳性球菌SSI方面显示出统计学上的显着差异。然而,这个证据的确定性很低。
结论：本系统综述和荟萃分析显示，关于VCM粉剂降低骨科大手术中SSI的效果尚无定论。需要使用严格方法的进一步试验来阐明这种干预的效果。
目的：阐明外用VCM粉预防骨科大手术的效果。
方法：MEDLINE，Embase,中部,ICTRP,和ClinicalTrials.gov数据库从成立到2023年9月25日进行了搜索。我们纳入了随机对照试验，比较了局部用VCM粉和对照组在大型骨科手术中预防SSI的作用。两名审稿人独立筛选标题和摘要，并提取相关数据，其次是评估偏倚的风险和证据的确定性。主要结果指标是总体SSI，再操作,和不良事件。使用随机效应荟萃分析获得总结结果。我们进行了试验序贯分析(TSA)。
结果：8项随机对照试验提供了4,307名参与者的数据。VCM粉末在降低总体SSI方面没有差异。在我们的TSA中，患者的累积人数未超过所需的19,233信息大小，Z曲线没有越过试验序贯监测或无效边界，这表明荟萃分析的结果不确定。再次手术没有发现差异。在SSI中，VCM粉末在减少革兰氏阳性球菌SSI方面显示出统计学上的显着差异。然而,这个证据的确定性很低。
结论：本系统综述和荟萃分析显示，关于VCM粉剂降低骨科大手术中SSI的效果尚无定论。需要使用严格方法的进一步试验来阐明这种干预的效果。
