Pan A, De Angelis G, Nicastri E, Sganga G, Tacconelli E
Infectious and Tropical Diseases Unit, Istituti Ospitalieri di Cremona, 26100, Cremona, Italy,
Infection. 2013 Dec;41(6):1129-35. doi: 10.1007/s15010-013-0536-6. Epub 2013 Oct 5.
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.
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.
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.
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.
局部负压（TNP）已成为感染伤口的常用治疗方法。进行了一项系统评价和荟萃分析，以研究与传统疗法相比，TNP在治疗深部手术部位感染（SSI），特别是胸骨切开术后感染方面的疗效。
检索MEDLINE、EMBASE和Cochrane对照试验中央注册库，查找截至2012年2月发表的比较TNP与传统治疗方法治疗深部SSI的随机临床试验（RCT）和观察性研究。通过GRADE系统评估研究质量，通过纽卡斯尔-渥太华量表（NOS）评估偏倚风险。主要结局是感染治愈/伤口愈合率。次要结局是不良事件、住院时间、死亡率和成本。结果以95%置信区间（95%CI）呈现，并将估计值报告为比值比（OR）。通过I²检验确定异质性，I²>50%被认为具有显著性。
在检索到的83项研究中，纳入了12项队列研究，共873例患者。所有研究质量均较低，12项中有11项存在中度偏倚风险，且均非RCT。与持续闭式引流相比，TNP治疗的患者伤口愈合更为常见（OR 6.45，95%CI 3.46 - 12.00）。与标准治疗相比，使用TNP可显著缩短住院时间（平均差值：8.21，95%CI - 12.19，- 4.23）。研究间检测到高度异质性，可由TNP比较器类型解释。
系统评价和荟萃分析表明，TNP在治愈深部SSI方面可能比标准疗法更有效。然而，需要多中心RCT来证实这种治疗方法的潜在价值。
