Do intra-wound antibiotics reduce the incidence of surgical site infections in pelvic and lower limb trauma surgery? A systematic review and meta-analysis

To analyse the efficacy of intra-operative topical antibiotics in reducing the incidence of post-operative surgical site infections in pelvic and lower limb trauma orthopaedic surgery.A search of Ovid MEDLINE, PubMed and Embase was conducted for English language studies published from 1946 through to September 3, 2021 using relevant keywords.Included studies were randomised controlled trials, cohort studies or case-control studies reporting on the rate of SSIs in adult patients (age 16 and over) that underwent surgical fixation of lower limb or pelvic traumatic fractures, including both open and closed fractures, with topical intra-operative antibiotics applied to the surgical site prior to wound closure.Studies were evaluated using the Joanna Briggs Institute Critical Appraisal Checklist for analytical cross-sectional studies. Risk of bias was assessed using the ROBINS-I and Cochrane risk of bias tools.A meta-analysis was conducted using the inverse variance method and random effects model to assess effect significance and study heterogeneity.Seven studies were included in the systematic review. Results of the meta-analysis suggested a potential 23% reduction in the odds of developing a deep surgical site infection in patients treated with intra-operative antibiotic powder compared with those managed with intravenous (IV) antibiotics alone (OR 0.77, 95% CI 0.52 - 1.13), although the results did not reach statistical significance. Further powered studies including randomised controlled trials would be of great value to validate the results suggested in this study and inform best practice intra-operative antibiotic prophylaxis in pelvic and lower limb trauma surgery.