title: Gentamicin-collagen implants to reduce surgical site infection: systematic review and meta-analysis of randomized trials.
abstract: OBJECTIVE
  To determine whether gentamicin-impregnated collagen sponges (gentamicin-collagen implants) decrease the incidence of surgical site infection (SSI).
  
  
  BACKGROUND
  SSIs cause substantial morbidity and increase the costs of healthcare. Antibiotic prophylaxis is a cornerstone of SSI reduction. Prophylactic local delivery of antibiotics with novel biodegradable drug carrier systems, such as the gentamicin-collagen implant, is a potential avenue for SSI reduction. Gentamicin-collagen implants have been previously assessed in multiple randomized controlled trials (RCTs) with conflicting results. Therefore, a systematic review and meta-analysis of all relevant RCTs was conducted to determine whether gentamicin-collagen implants reduce SSI.
  
  
  METHODS
  Major medical databases and trial registers were searched for published and unpublished RCTs. The endpoint of interest was the incidence of SSI. A random effects model was used and pooled estimates were reported as odds ratios (ORs), with the corresponding 95% confidence interval (CI). A subset analysis by incision type was planned a priori.
  
  
  RESULTS
  Fifteen RCTs encompassing a total of 6979 patients were included in the final analysis. The included studies were of moderate to high quality. Gentamicin-collagen implants significantly reduced SSI [OR = 0.51; 95% CI: 0.33-0.77; P = 0.001; number needed to treat (NNT) = 21; I = 75%]. These results were seen in subset analysis of clean (OR = 0.53; 95% CI: 0.33-0.87; P = 0.01; NNT = 30) and clean-contaminated surgery (OR = 0.43; 95% CI: 0.20-0.93; P = 0.03; NNT = 9) specifically.
  
  
  CONCLUSIONS
  Gentamicin-collagen implants decrease the rate of SSI.
authors.affiliation: Department of Surgery, Middlemore Hospital, Auckland, New Zealand. waikeat@hotmail.co.uk
authors.forename: Wai Keat
authors.initials: WK
authors.lastname: Chang
authors.forename: Sanket
authors.initials: S
authors.lastname: Srinivasa
authors.forename: Andrew D
authors.initials: AD
authors.lastname: MacCormick
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Hill
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D003094:Collagen / Q000627:therapeutic use*; D004343:Drug Implants; D005839:Gentamicins / Q000627:therapeutic use*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D004343:Drug Implants; D005839:Gentamicins; D003094:Collagen