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Topical negative pressure to treat surgical site infections, with a focus on post-sternotomy infections: a systematic review and meta-analysis

  • Clinical and Epidemiological Study
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Abstract

Purpose

Topical negative pressure (TNP) has become a common treatment of infected wounds. A systematic review and meta-analysis was performed to investigate TNP efficacy compared to conventional therapy in the treatment of deep surgical site infections (SSIs), particularly post-sternotomy infections.

Methods

MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched for randomized clinical trials (RCTs) and observational studies comparing TNP to conventional treatment in deep SSIs published up to February 2012. Study quality was evaluated through the GRADE system and bias risk through the Newcastle–Ottawa scale (NOS). Primary outcome was infection cure/wound resolution rate. Secondary outcomes were adverse events, length of stay, mortality, and costs. The results are presented with 95 % confidence intervals (95 % CIs) and report estimates as odds ratios (ORs). Heterogeneity was determined through the I 2 test, with >50 % being considered significant.

Results

Among 83 studies retrieved, 12 cohort studies including 873 patients were considered. All the studies were of low quality, 11/12 had a medium risk of bias, and none were RCTs. Wound resolution was obtained more frequently in TNP-treated patients as compared with continuous and closed drainage (OR 6.45, 95 % CI 3.46–12.00). TNP use was associated with significant reduction of length of stay compared with standard of care (mean difference: 8.21, 95 % CI −12.19, −4.23). High heterogeneity was detected between studies, explained by the TNP comparator type.

Conclusions

The systematic review and meta-analysis suggest that TNP might be more effective than standard therapy in the cure of deep SSIs. However, multicenter RCTs are needed to confirm the potential value of this treatment.

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Conflict of interest

No author has any conflict nor funding to declare.

Author information

Authors and Affiliations

  1. Infectious and Tropical Diseases Unit, Istituti Ospitalieri di Cremona, 26100, Cremona, Italy

    A. Pan

  2. Infectious Risk Area, Health and Social Regional Agency of Emilia-Romagna, Bologna, Italy

    A. Pan

  3. Department of Infectious Diseases, Università Cattolica, Rome, Italy

    G. De Angelis & E. Tacconelli

  4. National Institute of Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy

    E. Nicastri

  5. Division of General Surgery and Organ Transplantation, Department of Surgery, Università Cattolica, Rome, Italy

    G. Sganga

  6. Department of Infectious Diseases, University of Tübingen, Tübingen, Germany

    E. Tacconelli

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  1. A. Pan
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  2. G. De Angelis
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  4. G. Sganga
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  5. E. Tacconelli
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Corresponding author

Correspondence to A. Pan.

Electronic supplementary material

Below are the links to the electronic supplementary material.

15010_2013_536_MOESM1_ESM.png

Supplementary material 1 (PNG 63 kb) Fig. E1 Time to healing, expressed in days, in patients with SSIs treated with TNP or standard of care. Legend: Mean and standard deviation (SD) of time to healing among the TNP group and controls

15010_2013_536_MOESM2_ESM.eps

Supplementary material 2 (EPS 596 kb) Fig. E2. Crude mortality in patients with SSIs treated with TNP or standard of care. E2a: overall mortality at the last follow-up visit reported in the study. E2b: short-term mortality (in-hospital to 3 months). E2c: long-term mortality (6 to 12 months) Legend: The labels Events and Total refer to number of patients deceased and total included cases, respectively, among the TNP group and controls

Supplementary material 3 (EPS 369 kb)

15010_2013_536_MOESM4_ESM.pdf

Supplementary material 4 (PDF 14 kb) Fig. E3. Funnel plot of studies assessing the primary outcome. SE, standard error; log, logarithm; OR, odds ratio

Supplementary material 5 (DOC 99 kb)

Supplementary material 6 (DOC 35 kb)

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Pan, A., De Angelis, G., Nicastri, E. et al. Topical negative pressure to treat surgical site infections, with a focus on post-sternotomy infections: a systematic review and meta-analysis. Infection 41, 1129–1135 (2013). https://doi.org/10.1007/s15010-013-0536-6

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  • DOI: https://doi.org/10.1007/s15010-013-0536-6

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