Surgical site infection in the presence oforthopaedic implantsposes a significant healthcare and socio-economic burden. In order to assess the potential of various prevention strategies against Staphylococcus-induced stainless steel-associated infections, a review of animal evidencewas designed.
The databases ofPubMed, Embase, and CENTRAL were searched until 10 March 2020 for articles including animal models with stainless steel instrumentationand techniques to prevent Staphylococcus infection. We conducted random effects meta-analysis of standardized mean differences (SMD) with subgroup analysis linked to various protection strategies and we recorded complications. Quality was assessed with the SYRCLE's risk of bias tool.
Twenty-six studies were included. Combined active coating (featuring organicantibacterial compound release) and degradable passivefinishing (lipid- or polymer-based structure modification reducing bacterial adhesion) was favored over untreatedcontrols (SMDs for Methicillin-sensitive Staphylococcus aureus [MSSA] and Methicillin-resistant Staphylococcus aureus [MRSA] were -3.46, 95% CI [-4.53 to -2.4], p < 0.001[n = 4 head-to-head comparisons]; and -6.67, 95% CI [-10.53 to -3], p < 0.001[n = 5 head-to-head comparisons], respectively).Systemic vitamin D supplementation and systemic antibiotic administration with or without local antibiotics demonstrated favorable outcomes against MSSA infection. On the other hand, no benefit was seen following vaccination. Of note, no side effects were documented.
Based on data gathered from 8 studies, which comprised 294 animals, a bioresorbable polymer- or lipid-based surface modification supplemented with organiccoating yielded improved infection-related outcomes against MSSA and MRSA stainless steel infections, and therefore this strategy could be further investigated in human research.
