title: Control strategies to prevent total hip replacement-related infections: a systematic review and mixed treatment comparison.
abstract: OBJECTIVE
  To synthesise the available evidence and estimate the comparative efficacy of control strategies to prevent total hip replacement (THR)-related surgical site infections (SSIs) using a mixed treatment comparison.
  
  
  METHODS
  Systematic review and mixed treatment comparison.
  
  
  METHODS
  Hospital and other healthcare settings.
  
  
  METHODS
  Patients undergoing THR.
  
  
  METHODS
  The number of THR-related SSIs occurring following the surgical operation.
  
  
  RESULTS
  12 studies involving 123 788 THRs and 9 infection control strategies were identified. The strategy of 'systemic antibiotics+antibiotic-impregnated cement+conventional ventilation' significantly reduced the risk of THR-related SSI compared with the referent strategy (no systemic antibiotics+plain cement+conventional ventilation), OR 0.13 (95% credible interval (CrI) 0.03-0.35), and had the highest probability (47-64%) and highest median rank of being the most effective strategy. There was some evidence to suggest that 'systemic antibiotics+antibiotic-impregnated cement+laminar airflow' could potentially increase infection risk compared with 'systemic antibiotics+antibiotic-impregnated cement+conventional ventilation', 1.96 (95% CrI 0.52-5.37). There was no high-quality evidence that antibiotic-impregnated cement without systemic antibiotic prophylaxis was effective in reducing infection compared with plain cement with systemic antibiotics, 1.28 (95% CrI 0.38-3.38).
  
  
  CONCLUSIONS
  We found no convincing evidence in favour of the use of laminar airflow over conventional ventilation for prevention of THR-related SSIs, yet laminar airflow is costly and widely used. Antibiotic-impregnated cement without systemic antibiotics may not be effective in reducing THR-related SSIs. The combination with the highest confidence for reducing SSIs was 'systemic antibiotics+antibiotic-impregnated cement+conventional ventilation'. Our evidence synthesis underscores the need to review current guidelines based on the available evidence, and to conduct further high-quality double-blind randomised controlled trials to better inform the current clinical guidelines and practice for prevention of THR-related SSIs.
authors.affiliation: Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Henry
authors.initials: H
authors.lastname: Zheng
authors.forename: Adrian G
authors.initials: AG
authors.lastname: Barnett
authors.forename: Katharina
authors.initials: K
authors.lastname: Merollini
authors.forename: Alex
authors.initials: A
authors.lastname: Sutton
authors.forename: Nicola
authors.initials: N
authors.lastname: Cooper
authors.forename: Tony
authors.initials: T
authors.lastname: Berendt
authors.forename: Jennie
authors.initials: J
authors.lastname: Wilson
authors.forename: Nicholas
authors.initials: N
authors.lastname: Graves
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001843:Bone Cements; D006801:Humans; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014691:Ventilation
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements
keywords: EPIDEMIOLOGY