Antimicrobial dressings for the prevention of surgical site infection: a systematic review and meta-analysis

Authors:
Suraya Yusuf, Jonathan James, Bryant Chong, Esmee Dohle, Luka Jovanovic, Ryckie Wade, Justin Wormald

Body of Abstract:
Background

Surgical site infections (SSI) are a leading cause of postoperative morbidity, prolonged hospitalisation, and significant healthcare costs. Antimicrobial dressings may mitigate SSI risk by minimising local microbial burden, but their effectiveness remains uncertain.

Methods

MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL were searched from inception to July 2024, supplemented by searches of clinical trial registries, grey literature, and citation chasing. Randomised controlled trials (RCTs) comparing antimicrobial dressings with any other inert dressing for closed incisional wounds following elective or emergency surgery were included. Data were extracted in duplicate, risk of bias was assessed with RoB 2, and certainty of evidence with GRADE. Pairwise random-effects meta-analyses were performed. The primary outcome was SSI within 30 days (90 days if prosthesis used); secondary outcomes included adverse events and costs.

Results:

Thirty-five RCTs involving 8718 participants were included. Meta-analyses were conducted for silver (21 studies, n=5504), dialkylcarbomyl chloride (DACC) (3 studies, n=892), and mupirocin (3 studies, n=1320). Compared to standard dressings, silver dressings reduced the risk of SSI by 22% (RR 0.78; CI 0.62-0.97; I²=43%; moderate-certainty evidence). DACC dressings halved the risk of SSI (RR 0.49; CI 0.29-0.83; I²=0%; moderate-certainty) compared to standard dressings. Mupirocin dressings were not associated with SSI prevention (RR 0.62; 95% CI 0.15-2.63; I²=67%; very low-certainty evidence). Evidence for other agents was insufficient.

Conclusion:

Silver and DACC dressings probably reduce the risk of SSI in closed surgical wounds. There is residual uncertainty over the clinical effectiveness of other antimicrobial dressings.