{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T16:36:30Z","timestamp":1788280590176,"version":"build-2803163510"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2022,1,17]],"date-time":"2022-01-17T00:00:00Z","timestamp":1642377600000},"content-version":"vor","delay-in-days":77,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,11,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Topical antibiotics are widely prescribed as prophylaxis for surgical site infection (SSI). Despite giving high drug concentrations at local wound sites, their efficacy remains controversial. This study is a systematic review and meta-analysis designed to compare the efficacy and safety of topical antibiotics with non-antibiotic agents in preventing SSI.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Randomized controlled trials (RCTs) comparing topical antibiotics in patients with clean and clean-contaminated postsurgical wounds were included. Relevant trials published before 30 September 2020, were searched in the PubMed, Embase, and Cochrane databases, without language restrictions. The primary outcome was the incidence of SSIs, presented as the event rate. The secondary outcome was the incidence of contact dermatitis (safety outcome). Data were synthesized using the random-effects model, with the results expressed as risk ratio (RR) with 95 per cent confidence intervals (c.i.).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Thirteen RCTs were included. The incidence of SSIs and contact dermatitis showed no significant difference between topical antibiotics and non-antibiotic agents (RR 0.89, 95 per cent c.i. 0.59 to 1.32 (P = 0.56, I2 = 48 per cent); and RR 2.79, 95 per cent c.i. 0.51 to 15.19 (P = 0.24, I2 = 0 per cent), respectively). In the subgroup analyses, a reduction in SSIs was also not observed in dermatological (RR 0.77, 95 per cent c.i. 0.39 to 1.55; P = 0.46, I2 = 65 per cent), ocular (RR 0.08, 95 per cent c.i. 0.00 to 1.52; P = 0.09), spinal (RR 1.34, 95 per cent c.i. 0.65 to 2.77; P = 0.43, I2 = 0 per cent), orthopaedic (RR 0.69, 95 per cent c.i. 0.37 to 1.29; P = 0.25, I2 = 0 per cent), or cardiothoracic surgeries (RR 1.60, 95 per cent c.i. 0.79 to 3.25; P = 0.19).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Given the current evidence, the routine application of topical antibiotics to surgical wounds did not reduce the incidence of SSI. Further trials are needed to assess their effectiveness in high-risk surgeries or in selected patient groups.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrab125","type":"journal-article","created":{"date-parts":[[2021,10,29]],"date-time":"2021-10-29T19:10:27Z","timestamp":1635534627000},"source":"Crossref","is-referenced-by-count":34,"title":["Topical antibiotic prophylaxis for surgical wound infections in clean and clean-contaminated surgery: a systematic review and meta-analysis"],"prefix":"10.1093","volume":"5","author":[{"given":"Po-Jung","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Chi Mei Medical Center , Tainan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Ming","family":"Hua","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Chi Mei Medical Center , Tainan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han Siong","family":"Toh","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Chi Mei Medical Center , Tainan, Taiwan"},{"name":"Institute of Clinical Medicine, College of Medicine, National Cheng Kung University , Tainan, Taiwan"},{"name":"Department of Health and Nutrition, Chia Nan University of Pharmacy & Science , Tainan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei-Chuan","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Chi Mei Medical Center , Tainan, Taiwan"},{"name":"Department of Public Health, College of Medicine, National Cheng Kung University , Tainan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,1,17]]},"reference":[{"key":"2023020211093741100_zrab125-B1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jhin.2017.03.004","article-title":"Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries","volume":"96","author":"Badia","year":"2017","journal-title":"J Hosp Infect"},{"key":"2023020211093741100_zrab125-B2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1017\/ice.2019.296","article-title":"Antimicrobial-resistant pathogens associated with adult healthcare-associated infections: summary of data reported to the National Healthcare Safety Network, 2015\u20132017","volume":"41","author":"Weiner-Lastinger","year":"2020","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2023020211093741100_zrab125-B3","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1001\/jamasurg.2017.0904","article-title":"Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017","volume":"152","author":"Berr\u00edos-Torres","year":"2017","journal-title":"JAMA Surg"},{"key":"2023020211093741100_zrab125-B4","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1086\/644732","article-title":"Topical antimicrobial therapy for treating chronic wounds","volume":"49","author":"Lipsky","year":"2009","journal-title":"Clin Infect Dis"},{"key":"2023020211093741100_zrab125-B5","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1093\/jac\/dkr009","article-title":"The role of topical antibiotics used as prophylaxis in surgical site infection prevention","volume":"66","author":"McHugh","year":"2011","journal-title":"J Antimicrob Chemother"},{"key":"2023020211093741100_zrab125-B6","doi-asserted-by":"crossref","first-page":"e276","DOI":"10.1016\/S1473-3099(16)30398-X","article-title":"New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective","volume":"16","author":"Allegranzi","year":"2016","journal-title":"Lancet Infect Dis"},{"key":"2023020211093741100_zrab125-B7","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1089\/sur.2018.279","article-title":"Use of topical antibiotics before primary incision closure to prevent surgical site infection: a meta-analysis","volume":"20","author":"L\u00f3pez-Cano","year":"2019","journal-title":"Surg Infect (Larchmt)"},{"key":"2023020211093741100_zrab125-B8","doi-asserted-by":"crossref","first-page":"e288","DOI":"10.1016\/S1473-3099(16)30402-9","article-title":"New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective","volume":"16","author":"Allegranzi","year":"2016","journal-title":"Lancet Infect Dis"},{"key":"2023020211093741100_zrab125-B9","volume-title":"Surgical Site Infections: Prevention and Treatment","author":"National Institute for Health and Care Excellence: Clinical Guidelines","year":"2020"},{"key":"2023020211093741100_zrab125-B10","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.clineuro.2014.07.018","article-title":"Nasal MRSA colonization: impact on surgical site infection following spine surgery","volume":"125","author":"Thakkar","year":"2014","journal-title":"Clin Neurol Neurosurg"},{"key":"2023020211093741100_zrab125-B11","doi-asserted-by":"crossref","first-page":"417","DOI":"10.2147\/IDR.S151293","article-title":"A systematic review and meta-analysis on the use of prophylactic topical antibiotics for the prevention of uncomplicated wound infections","volume":"11","author":"Tong","year":"2018","journal-title":"Infect Drug Resist"},{"key":"2023020211093741100_zrab125-B12","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/S0196-6553(99)70088-X","article-title":"Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee","volume":"27","author":"Mangram","year":"1999","journal-title":"Am J Infect Control"},{"key":"2023020211093741100_zrab125-B13","author":"Shuster"},{"key":"2023020211093741100_zrab125-B14","doi-asserted-by":"crossref","first-page":"b2700","DOI":"10.1136\/bmj.b2700","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration","volume":"339","author":"Liberati","year":"2009","journal-title":"BMJ"},{"key":"2023020211093741100_zrab125-B15","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/0197-2456(86)90046-2","article-title":"Meta-analysis in clinical trials","volume":"7","author":"DerSimonian","year":"1986","journal-title":"Control Clin Trials"},{"key":"2023020211093741100_zrab125-B16","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1002\/bjs.5400","article-title":"Randomized clinical trial of the effect of applying ointment to surgical wounds before occlusive dressing","volume":"93","author":"Dixon","year":"2006","journal-title":"Br J Surg"},{"key":"2023020211093741100_zrab125-B17","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1001\/jama.1996.03540120050033","article-title":"Infection and allergy incidence in ambulatory surgery patients using white petrolatum vs bacitracin ointment. A randomized controlled trial","volume":"276","author":"Smack","year":"1996","journal-title":"JAMA"},{"key":"2023020211093741100_zrab125-B18","doi-asserted-by":"crossref","first-page":"S30","DOI":"10.1016\/j.jaad.2010.11.009","article-title":"Postprocedural wound-healing efficacy following removal of dermatosis papulosa nigra lesions in an African American population: a comparison of a skin protectant ointment and a topical antibiotic","volume":"64","author":"Taylor","year":"2011","journal-title":"J Am Acad Dermatol"},{"key":"2023020211093741100_zrab125-B19","doi-asserted-by":"crossref","first-page":"a2812","DOI":"10.1136\/bmj.a2812","article-title":"Does single application of topical chloramphenicol to high risk sutured wounds reduce incidence of wound infection after minor surgery? Prospective randomised placebo controlled double blind trial","volume":"338","author":"Heal","year":"2009","journal-title":"BMJ"},{"key":"2023020211093741100_zrab125-B20","doi-asserted-by":"crossref","first-page":"S23","DOI":"10.1016\/j.jaad.2010.11.010","article-title":"A comparison of postprocedural wound care treatments: do antibiotic-based ointments improve outcomes?","volume":"64","author":"Draelos","year":"2011","journal-title":"J Am Acad Dermatol"},{"key":"2023020211093741100_zrab125-B21","first-page":"126","article-title":"Umbilical port-site complications in laparoscopic cholecystectomy: role of topical antibiotic therapy","volume":"12","author":"Neri","year":"2008","journal-title":"JSLS"},{"key":"2023020211093741100_zrab125-B22","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1086\/341025","article-title":"Surgical site infections in orthopedic surgery: the effect of mupirocin nasal ointment in a double-blind, randomized, placebo-controlled study","volume":"35","author":"Kalmeijer","year":"2002","journal-title":"Clin Infect Dis"},{"key":"2023020211093741100_zrab125-B23","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1016\/j.injury.2005.01.001","article-title":"Role of topical antibiotics in hip surgery. A prospective randomised study","volume":"36","author":"Kamath","year":"2005","journal-title":"Injury"},{"key":"2023020211093741100_zrab125-B24","first-page":"35","article-title":"Intrawound application of vancomycin changes the responsible germ in elective spine surgery without significant effect on the rate of infection: a randomized prospective study","volume":"102","author":"Mirzashahi","year":"2018","journal-title":"Musculoskelet Surg"},{"key":"2023020211093741100_zrab125-B25","doi-asserted-by":"crossref","first-page":"2149","DOI":"10.1097\/BRS.0000000000000015","article-title":"Effects of using intravenous antibiotic only versus local intrawound vancomycin antibiotic powder application in addition to intravenous antibiotics on postoperative infection in spine surgery in 907 patients","volume":"38","author":"Tubaki","year":"2013","journal-title":"Spine (Phila Pa 1976)"},{"key":"2023020211093741100_zrab125-B26","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1016\/j.ophtha.2020.07.032","article-title":"The role of topical antibiotic prophylaxis in oculofacial plastic surgery: a randomized controlled study","volume":"127","author":"Ashraf","year":"2020","journal-title":"Ophthalmology"},{"key":"2023020211093741100_zrab125-B27","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1111\/pace.12280","article-title":"The role of prophylaxis topical antibiotics in cardiac device implantation","volume":"37","author":"Khalighi","year":"2014","journal-title":"Pacing Clin Electrophysiol"},{"key":"2023020211093741100_zrab125-B28","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.jhin.2006.06.010","article-title":"Impact of treating Staphylococcus aureus nasal carriers on wound infections in cardiac surgery","volume":"64","author":"Konvalinka","year":"2006","journal-title":"J Hosp Infect"},{"key":"2023020211093741100_zrab125-B29","first-page":"35","article-title":"Therapeutic guidelines: antibiotic","volume":"18","author":"Leggat","year":"2010","journal-title":"J Mil Veterans Health"},{"key":"2023020211093741100_zrab125-B30","first-page":"CD011426","article-title":"Topical antibiotics for preventing surgical site infection in wounds healing by primary intention","volume":"11","author":"Heal","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"2023020211093741100_zrab125-B31","doi-asserted-by":"crossref","first-page":"151","DOI":"10.3109\/09546634.2014.906547","article-title":"Topical antibiotic prophylaxis for prevention of surgical wound infections from dermatologic procedures: a systematic review and meta-analysis","volume":"26","author":"Saco","year":"2015","journal-title":"J Dermatolog Treat"},{"key":"2023020211093741100_zrab125-B32","doi-asserted-by":"crossref","first-page":"56","DOI":"10.3390\/antibiotics9020056","article-title":"Antibiotic delivery strategies to treat skin infections when innate antimicrobial defense fails","volume":"9","author":"Smith","year":"2020","journal-title":"Antibiotics"},{"key":"2023020211093741100_zrab125-B33","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1016\/j.addr.2006.07.027","article-title":"Challenges and obstacles of ocular pharmacokinetics and drug delivery","volume":"58","author":"Urtti","year":"2006","journal-title":"Adv Drug Deliv Rev"},{"key":"2023020211093741100_zrab125-B34","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.survophthal.2019.12.001","article-title":"Infection prophylaxis in periorbital Mohs surgery and reconstruction: a review and update to recommendations","volume":"65","author":"DelMauro","year":"2020","journal-title":"Surv Ophthalmol"},{"key":"2023020211093741100_zrab125-B35","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1001\/jamafacial.2019.1027","article-title":"Postoperative antibiotic use among patients undergoing functional facial plastic and reconstructive surgery","volume":"21","author":"Olds","year":"2019","journal-title":"JAMA Facial Plast Surg"},{"key":"2023020211093741100_zrab125-B36","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1016\/j.spinee.2013.06.030","article-title":"An evidence-based clinical guideline for antibiotic prophylaxis in spine surgery","volume":"13","author":"Shaffer","year":"2013","journal-title":"Spine J"},{"key":"2023020211093741100_zrab125-B37","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.clineuro.2019.05.017","article-title":"Cefazolin versus vancomycin for neurosurgical operative prophylaxis - a single institution retrospective cohort study","volume":"182","author":"Nguyen","year":"2019","journal-title":"Clin Neurol Neurosurg"},{"key":"2023020211093741100_zrab125-B38","doi-asserted-by":"crossref","first-page":"2972","DOI":"10.1007\/s00586-019-06143-6","article-title":"Meta-analysis of topical vancomycin powder for microbial profile in spinal surgical site infections","volume":"28","author":"Li","year":"2019","journal-title":"Eur Spine J"},{"key":"2023020211093741100_zrab125-B39","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.1177\/106002809803200104","article-title":"New approaches to reduce Staphylococcus aureus nosocomial infection rates: treating S. aureus nasal carriage","volume":"32","author":"Perl","year":"1998","journal-title":"Ann Pharmacother"},{"key":"2023020211093741100_zrab125-B40","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/0195-6701(95)90079-9","article-title":"The significance of nasal carriage of Staphylococcus aureus and the incidence of postoperative wound infection","volume":"31","author":"Wenzel","year":"1995","journal-title":"J Hosp Infect"},{"key":"2023020211093741100_zrab125-B41","doi-asserted-by":"crossref","first-page":"152s","DOI":"10.1016\/0002-9343(91)90361-Z","article-title":"Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System","volume":"91","author":"Culver","year":"1991","journal-title":"Am J Med"},{"key":"2023020211093741100_zrab125-B42","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1056\/NEJMoa0808939","article-title":"Preventing surgical-site infections in nasal carriers of Staphylococcus aureus","volume":"362","author":"Bode","year":"2010","journal-title":"N Engl J Med"},{"key":"2023020211093741100_zrab125-B43","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1111\/ajd.12028","article-title":"Nasal carriage of Staphylococcus aureus in patients undergoing Mohs micrographic surgery is an important risk factor for postoperative surgical site infection: a prospective randomised study","volume":"54","author":"Tai","year":"2013","journal-title":"Australas J Dermatol"}],"container-title":["BJS Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/5\/6\/zrab125\/49054959\/zrab125.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/5\/6\/zrab125\/49054959\/zrab125.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T13:24:51Z","timestamp":1675344291000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjsopen\/article\/doi\/10.1093\/bjsopen\/zrab125\/6509477"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,1]]},"references-count":43,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2021,11,9]]}},"URL":"https:\/\/doi.org\/10.1093\/bjsopen\/zrab125","relation":{},"ISSN":["2474-9842"],"issn-type":[{"value":"2474-9842","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,11,1]]},"published":{"date-parts":[[2021,11,1]]},"article-number":"zrab125"}}