Povidone Iodine vs Chlorhexidine Gluconate for Preoperative Skin Antisepsis: A Systematic Review and Meta-analysis of Randomised Controlled Trials.

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection Pub Date : 2024-09-21 DOI:10.1016/j.jhin.2024.09.005

Ana Clara Felix de Farias Santos, Fernanda Valeriano Zamora, Lorhayne Kerly Capuchinho Scalioni Galvao, Nicole Dos Santos Pimenta, Deivyd Vieira Silva Cavalcante, João Pedro Costa Esteves Almuinha Salles, Sara Hira, Andres Villca Zamora

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引用次数: 0

Abstract

Background: Surgical site infection (SSI) remains a challenge in healthcare, contributing to prolonged hospital stays, increased healthcare costs, and adverse patient outcomes, including mortality. Effective preoperative skin disinfection interventions, such as povidone-iodine (PVI) and chlorhexidine (CHG), are widely used but their efficacy remains debated. To address this gap, this meta-analysis aims to evaluate the efficacy of PVI and CHG.

Method: We searched PubMed, Embase, and Cochrane databases up to June 2024 to identify studies comparing PVI versus CHG for preoperative skin antisepsis. We calculated odds ratios (ORs) for binary outcomes, with 95% confidence intervals (CIs). A random-effects model was used with statistical significance set at p < 0.05. Data were analysed using R software (version 4.4.0), and heterogeneity was assessed using I² statistics.

Findings: Sixteen randomised controlled trials (RCTs) were included, involving a total of 13,721 patients, among whom 6,836 (49.8%) received PVI. Compared to CHG, PVI was associated with a non-significant reduction in deep SSI (OR 1.00; 95% CI 0.66 - 1.50; p = 0.994), but an increased risk of overall SSI (OR 1.25; 95% CI 1.06 - 1.48; p = 0.007) and superficial SSI (OR 1.67; 95% CI 1.25 - 2.24; p < 0.001).

Conclusion: PVI as preoperative skin antisepsis demonstrated a non-significant reduction in deep SSI compared to CHG but was associated with an increased risk of overall and superficial SSI. Despite these findings, PVI remains an effective option, especially in resource-limited settings. Further research is needed to optimise its use and improve infection prevention strategies in clinical practice.

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用于术前皮肤防腐的聚维酮碘与葡萄糖酸氯己定：随机对照试验的系统回顾和元分析》。

背景：手术部位感染（SSI）仍是医疗保健领域的一项挑战，它导致住院时间延长、医疗保健成本增加以及包括死亡率在内的不良患者预后。聚维酮碘 (PVI) 和洗必泰 (CHG) 等有效的术前皮肤消毒干预措施被广泛使用，但其疗效仍存在争议。为了填补这一空白，本荟萃分析旨在评估 PVI 和 CHG 的疗效：我们检索了截至 2024 年 6 月的 PubMed、Embase 和 Cochrane 数据库，以确定比较 PVI 和 CHG 术前皮肤防腐效果的研究。我们计算了二元结果的几率比（OR）以及 95% 的置信区间（CI）。采用随机效应模型，统计显著性设定为 p < 0.05。使用 R 软件（4.4.0 版）分析数据，并使用 I2 统计量评估异质性：共纳入16项随机对照试验（RCT），涉及13721名患者，其中6836人（49.8%）接受了PVI治疗。与CHG相比，PVI与深部SSI的减少无显著相关性（OR 1.00; 95% CI 0.66 - 1.50; p = 0.994），但总体SSI（OR 1.25; 95% CI 1.06 - 1.48; p = 0.007）和浅表SSI（OR 1.67; 95% CI 1.25 - 2.24; p < 0.001）的风险增加：结论：与 CHG 相比，PVI 作为术前皮肤防腐剂可显著减少深部 SSI，但会增加整体和浅表 SSI 的风险。尽管有这些发现，PVI 仍是一种有效的选择，尤其是在资源有限的环境中。在临床实践中，需要进一步研究如何优化其使用并改进感染预防策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Hospital Infection 医学-传染病学

CiteScore

12.70

自引率

5.80%

发文量

271

审稿时长

19 days

期刊介绍： The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience. The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that: provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings; provide new insight into cleaning, disinfection and decontamination; provide new insight into the design of healthcare premises; describe novel aspects of outbreaks of infection; throw light on techniques for effective antimicrobial stewardship; describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control; improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change; improve understanding of the use of IT systems in infection surveillance and prevention and control.