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Title: Control strategies to prevent total hip replacement-related infections: a systematic review and mixed treatment comparison
Authors: Zheng, H.
Barnett, A. G.
Merollini, K.
Sutton, Alex
Cooper, Nicola
Berendt, T.
Wilson, J.
Graves, N.
First Published: 6-Mar-2014
Publisher: BMJ Publishing Group
Citation: BMJ Open 2014;4:e003978
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 double-blind randomised controlled trials to better inform the current clinical guidelines and practice for prevention of THR-related SSIs.
DOI Link: 10.1136/bmjopen-2013-003978
ISSN: 2044-6055
eISSN: 2044-6055
Version: Publisher Version
Status: Peer-reviewed
Type: Journal Article
Rights: 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. See:
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Appears in Collections:Published Articles, Dept. of Health Sciences

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