Li Hui-Zi, Zhang Lei, Chen Jia-Xi, Zheng Yang, Zhu Xiang-Nan
Department of General Surgery, The Fourth Affiliated Hospital of NanChang University, Nanchang, Jiangxi, China.
Department of Biliary-Pancreatic Surgery, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics, Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
J Surg Res. 2017 Jul;215:98-107. doi: 10.1016/j.jss.2017.03.040. Epub 2017 Apr 2.
Silver-containing dressings for the prevention of surgical site infections (SSIs) remained controversial, and accumulating evidence was lacking, so a meta-analysis was conducted to systematically assess the effectiveness and safety of silver-containing dressings for clean and clean-contaminated surgical incisions.
Pubmed, Embase, and the Cochrane Library were searched from the inception to February 2016 for randomized controlled trials (RCTs), which explored silver-containing dressings for the prevention of SSIs in clean and clean-contaminated operations. Relative risk (RR) with 95% confidence interval (CI) was pooled using random effects model. Predefined subgroup analyses, sensitivity analyses, and influence analyses were further undertaken.
Nine RCTs totaling 2196 patients (1141 in silver-containing group and 1055 in control group) were included. Silver-containing dressings did not effectively prevent the incidence of SSIs (9 RCTs; RR: 0.92; 95% CI: 0.66-1.29; I = 40%), superficial SSIs (5 RCTs; RR: 0.67; 95% CI: 0.36-1.24; I = 36%), and deep SSIs (5 RCTs; RR: 0.78; 95% CI: 0.41-1.49; I = 0). Subgroup analyses, sensitivity analyses, and influence analyses confirmed the robustness of the pooled estimate.
The current available evidence indicated that silver-containing dressing as compared with silver-free dressing was not associated with lower incidence of SSIs. Considering the quality of evidence ranking very low, further studies with higher quality should be warranted.
含银敷料预防手术部位感染（SSIs）仍存在争议，且缺乏越来越多的证据，因此进行了一项荟萃分析，以系统评估含银敷料用于清洁和清洁-污染手术切口的有效性和安全性。
检索了从创刊至2016年2月的PubMed、Embase和Cochrane图书馆，以查找随机对照试验（RCTs），这些试验探讨了含银敷料在清洁和清洁-污染手术中预防SSIs的作用。采用随机效应模型汇总相对风险（RR）及95%置信区间（CI）。进一步进行了预定义的亚组分析、敏感性分析和影响分析。
纳入了9项RCTs，共2196例患者（含银敷料组1141例，对照组1055例）。含银敷料不能有效预防SSIs的发生率（9项RCTs；RR：0.92；95%CI：0.66-1.29；I²=40%）、浅表SSIs（5项RCTs；RR：0.67；95%CI：0.36-1.24；I²=36%）和深部SSIs（5项RCTs；RR：0.78；95%CI：0.41-1.49；I²=0）。亚组分析、敏感性分析和影响分析证实了汇总估计的稳健性。
目前可得的证据表明，与不含银的敷料相比，含银敷料与较低的SSIs发生率无关。考虑到证据质量极低，应有必要开展更高质量的进一步研究。
