Prevention of Infection in Peripheral Arterial Reconstruction of the Lower Limb
Summary: This Cochrane review synthesizes evidence from 40 RCTs and quasi-RCTs involving 7970 participants on pharmacological and non-pharmacological interventions to prevent infections after lower limb peripheral arterial reconstruction. Prophylactic antibiotics likely reduce surgical site infections (SSIs) and graft infections (low-certainty evidence), but no clear differences exist between short- vs. long-duration regimens or antibiotic types (very low-certainty). Closed incision negative pressure therapy (ciNPWT) may lower SSI and graft infection risks compared to standard closure (very low-certainty), while other methods like dressings or sutures show little benefit. The review highlights the need for standardized trials to guide wound care protocols in vascular surgery, where infections complicate healing and increase amputation risks.
Key Highlights:
- Antibiotics vs. none: Reduced SSIs (RR 0.20, 95% CI 0.11-0.34; NNT 9) and graft infections (RR 0.19, 95% CI 0.06-0.63; low-certainty).
- Short vs. long antibiotics: No difference in SSIs (RR 0.75, 95% CI 0.40-1.40) or graft infections (very low-certainty).
- ciNPWT vs. standard: Possible reduction in SSIs (RR 0.49, 95% CI 0.27-0.86) and graft infections (RR 0.55, 95% CI 0.19-1.59; very low-certainty).
- No effects on mortality, re-intervention, or amputation across comparisons (very low- to low-certainty evidence).
- Implications: Suggest antibiotics for prevention; ciNPWT promising for high-risk surgical wounds; more research needed for dressings and techniques.
Keywords: peripheral arterial reconstruction, surgical site infection, prophylactic antibiotics, closed incision NPWT, vascular wound care