McGuinness Brandon, Ali Khatija Pinky, Phillips Steven, Stacey Michael
Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Princeton Innovation Center, Princeton University, Princeton, NJ, USA.
Vasc Endovascular Surg. 2020 Feb;54(2):147-161. doi: 10.1177/1538574419886957. Epub 2019 Nov 18.
Surgical site infection (SSI) presents a ubiquitous concern to surgical specialties, especially in the presence of prosthetic material. Antibiotic-impregnated beads present a novel and evolving means to combat this condition. This review aims to analyze the quality of evidence and methods of antibiotic bead use, particularly for application within vascular surgery.
A systematic scoping review was conducted within Embase, MEDLINE, and the Cochrane Registry of Randomized Controlled Trials. Articles were evaluated by 2 independent reviewers. Level of evidence was evaluated using the Oxford Center for Evidence-Based Medicine Criteria and the Cochrane Risk of Bias Tool for Randomized Controlled Trials.
The search yielded 6951 papers, with 275 included for final analysis. Publications increased in frequency from 1978 to the present. The most common formulation was polymethyl methacrylate; however publications on biodegradable formulations, including calcium sulfate beads, have been published with increasing frequency. Most publications had positive conclusions (94.2%); however, the data was mainly subjective and may be prone to publication bias. Only 11 randomized controlled trials were identified and all but one was evaluated to be at a high risk of bias. The most common indication was for osteomyelitis (52%), orthopedic prosthetic infections (20%), and trauma (9%). Within vascular surgery, beads have been used primarily for the treatment of graft infection, with freedom from recurrence rates being reported from 41% to 87.5%.
Antibiotic-impregnated beads provide a means to deliver high doses of antibiotic directly to a surgical site, without the risks of parenteral therapy. There has yet to be significant high-level quality data published on their use. There is a large body of evidence that suggests antibiotic beads may be used in SSIs in high-risk patients, prosthetic infections, and other complex surgical infections. Important potential areas of application in vascular surgery include graft infection, prevention of wound infection in high-risk patients, and diabetic foot infection.
手术部位感染（SSI）是外科专科普遍关注的问题，尤其是在存在假体材料的情况下。抗生素浸渍珠是对抗这种情况的一种新颖且不断发展的手段。本综述旨在分析抗生素珠使用的证据质量和方法，特别是在血管外科中的应用。
在Embase、MEDLINE和Cochrane随机对照试验注册库中进行了系统的范围综述。文章由2名独立审稿人评估。使用牛津循证医学中心标准和Cochrane随机对照试验偏倚风险工具评估证据水平。
检索到6951篇论文，其中275篇纳入最终分析。从1978年至今，出版物数量呈上升趋势。最常见的配方是聚甲基丙烯酸甲酯；然而，关于可生物降解配方（包括硫酸钙珠）的出版物越来越多。大多数出版物得出了积极的结论（94.2%）；然而，数据主要是主观的，可能存在发表偏倚。仅确定了11项随机对照试验，除一项外，所有试验均被评估为具有高偏倚风险。最常见的适应症是骨髓炎（52%）、骨科假体感染（20%）和创伤（9%）。在血管外科中，珠子主要用于治疗移植物感染，报道的无复发率为41%至87.5%。
抗生素浸渍珠提供了一种将高剂量抗生素直接输送到手术部位的方法，而没有肠外治疗的风险。关于其使用，尚未有大量高水平的高质量数据发表。有大量证据表明，抗生素珠可用于高危患者的手术部位感染、假体感染和其他复杂手术感染。在血管外科中重要的潜在应用领域包括移植物感染、高危患者伤口感染的预防和糖尿病足感染。
