University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom.
University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Birmingham Women's Hospital, Edgbaston, Birmingham B15 2TG, United Kingdom.
Eur J Obstet Gynecol Reprod Biol. 2021 Dec;267:226-233. doi: 10.1016/j.ejogrb.2021.11.014. Epub 2021 Nov 11.
OBJECTIVE(S): Surgical site infections (SSIs) are a common complication post-caesarean section. Advanced dressings aim to provide an optimal wound environment, primarily by physically or chemically controlling moisture, in order to promote timely healing. A systematic review and meta-analysis was conducted to evaluate the effectiveness of advanced dressings in SSI prevention post-caesarean section. Secondary effectiveness outcomes included superficial SSI, endometritis, wound dehiscence, rehospitalisation and length of rehospitalisation.
We conducted a systematic review and meta-analysis according to PRISMA guidelines. A protocol was registered a priori. MEDLINE, EMBASE, CENTRAL and CINAHL databases were searched from inception to May 2021, without date or language restrictions. Keywords included: caesarean section; bandages; dressing and surgical wound infection. Randomised controlled trials (RCTs) were included if they investigated any advanced dressing in women post-caesarean section compared to simple dressings and assessed SSI incidence. Relative risks (RR), with 95% confidence intervals (CIs) and p-values, were calculated using Review Manager software (RevMan version 5.0, The Cochrane Collaboration). I percentages were reported to assess heterogeneity and a funnel plot was produced to assess publication bias. Quality assessment was performed using the Cochrane Risk of Bias Assessment Tool. All data were double-extracted and discrepancies were finalised by a third reviewer.
From 253 citations identified, six RCTs were included in the systematic review and meta-analysis. Two studies investigated dialkylcarbamoyl chloride (DACC)-impregnated dressings; two investigated silver-impregnated dressings; one investigated copper-impregnated dressings and one investigated chlorhexidine gluconate dressings. The overall meta-analysis showed that advanced dressings did not reduce SSI risk (RR 0.81 [95% CI 0.52-1.24; p = 0.32]). However, subgroup analysis revealed that DACC-impregnated dressings reduced SSI risk (RR 0.33 [95% CI 0.14-0.77; p = 0.01]). Silver-impregnated dressings caused a nonsignificant increase in SSI risk (RR 1.20 [95% CI 0.77-1.88; p = 0.41]). All studies showed a high risk of bias.
This systematic review and meta-analysis suggests DACC dressings potentially reduce SSI. However we have shown no benefit of silver dressings. Further high-quality RCTs are required to recommend a change in clinical practice.
剖宫产术后切口感染是一种常见的并发症。先进的敷料旨在通过物理或化学方式控制水分，从而为伤口提供最佳的愈合环境，以促进伤口的及时愈合。本系统评价和荟萃分析旨在评估剖宫产术后使用先进敷料预防切口感染的效果。次要有效性结果包括切口浅层感染、子宫内膜炎、切口裂开、再入院和再入院时间。
我们根据 PRISMA 指南进行了系统评价和荟萃分析。该方案预先进行了注册。从建库到 2021 年 5 月，我们检索了 MEDLINE、EMBASE、CENTRAL 和 CINAHL 数据库，没有日期或语言限制。关键词包括：剖宫产术、绷带、敷料和手术部位感染。如果研究对象为接受剖宫产术的女性，将任何先进的敷料与简单的敷料进行比较，并评估切口感染的发生率，则将纳入随机对照试验（RCT）。使用 Review Manager 软件（RevMan 版本 5.0，Cochrane 协作组织）计算相对风险（RR）、95%置信区间（CI）和 p 值。使用 I ² 百分比评估异质性，并绘制漏斗图评估发表偏倚。使用 Cochrane 偏倚风险评估工具进行质量评估。所有数据均由两名研究者进行双份提取，最终结果由第三名研究者确定。
从 253 条引文中共纳入 6 项 RCT 进行系统评价和荟萃分析。其中 2 项研究调查了二烷基碳酰氯（DACC）浸渍敷料；2 项研究调查了银浸渍敷料；1 项研究调查了铜浸渍敷料；1 项研究调查了葡萄糖酸氯己定敷料。总体荟萃分析显示，先进的敷料并不能降低切口感染的风险（RR 0.81 [95%CI 0.52-1.24；p=0.32]）。然而，亚组分析显示，DACC 浸渍敷料可降低切口感染的风险（RR 0.33 [95%CI 0.14-0.77；p=0.01]）。银浸渍敷料会增加切口感染的风险，但无统计学意义（RR 1.20 [95%CI 0.77-1.88；p=0.41]）。所有研究均显示出较高的偏倚风险。
本系统评价和荟萃分析表明，DACC 敷料可能降低切口感染的风险，但我们并未发现银敷料有任何益处。需要进一步开展高质量的 RCT 来推荐改变临床实践。
